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直肠癌前切除肛门内结肠肛管双层吻合山西省肿瘤医院（０３００１３）罗导岷，孙诠，江波，高连魁高位直肠癌和部份中位直肠癌可以作前切除腹部盆腔内结肠─直肠吻合。术后排便功能尚满意，但操作困难，易复发。我们于１９８９年６月至１９９２年４月对１３例前切除病人，经肛口作结肠肛管烟筒样插入双吻合，效果良好。患者膀胱截石位，腹部操作同Ｍｉｌｌｅｓ，盆腔游离一定要深达肛管上端水平，从此端切断直肠，去肿瘤。扩张肛门后，用四根缝线或阴道拉钩牵开肛门，鼠齿钳钳夹肛管上端切缘。将保留结肠扎后，从肛门牵出。间断缝合肛管断端全层─牵出结肠浆肌层。再选择适当部位切断结肠，间断缝合结肠全层─肛管粘模，粘膜下层，成烟筒样插入双吻合。本组１３例手术，无一例吻合口瘘，肠管回缩，肠管坏死等并发症。该手术比传统腹腔内吻合，直肠下缘可多切除２～３ｃｍ，切除彻底，减少了复发，扩大了前切除的手术适应症。只要结肠血运良好，烟筒样插入吻合可以完全避免吻合口瘘。直肠癌前切除肛门内结肠肛管双层吻合@罗导岷，孙诠，江波，高连魁$山西省肿瘤医院
Anterior colon resection of anus in the colon Anal canal double anastomosis Shanxi Provincial Tumor Hospital (030013) Luo Daoyin, Sun Quan, Jiang Bo, Gao Liankui High rectal cancer and part of the median rectal cancer can be preexcised for intra-abdominal pelvic colon-rectal anastomosis . The function of bowel movement after the operation is still satisfactory, but the operation is difficult and easy to relapse. From June 1989 to April 1992, we performed 13 cases of patients who had undergone anterior resection of the anus and made an anus-like insertion of the colon anal canal. The results were good. The patient had bladder lithotomy and the abdomen was operated with Milles. The pelvic release must be as deep as the upper anal canal level. From there, the rectum was cut off and the tumor was removed. After the anus is expanded, the anus is retracted with four sutures or a vaginal hook. The rat tooth clamp clamps the cutting edge of the upper end of the anal canal. After retaining the colon, pull it out of the anus. Suturing the full length of the anal end of the anal canal - pulling out the colonic muscularis. Then select the appropriate part of the cut off the colon, intermittent suture the colon full layer - anal mucosal mold, submucosa, into the barrel into the double anastomosis. This group of 13 cases of surgery, no one case of anastomotic leakage, intestinal retraction, intestinal necrosis and other complications. The operation is more than the traditional intra-abdominal anastomosis, the lower rectum can be removed 2 ~ 3cm, thorough resection, reduce recurrence, expand the surgical indications of anterior resection. As long as the colon has good blood supply, an anastomosis like a chimney can completely avoid anastomotic leakage. Anterior rectal resection of anus and colon anal canal anastomosis @ Luo Daowei, Sun Quan, Jiang Bo, Gao Liangkui, Shanxi Cancer Hospital