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背景与目的:为保留肛门功能,提高患者生存质量,目前直肠癌的手术治疗逐渐呈现以前切除术取代腹会阴联合切除术的趋势。其中,吻合器技术为低位直肠癌前切除术提供更为可靠的吻合,扩大了前切除术的适应症。本研究总结449例应用吻合器行直肠癌根治性前切除术的经验,提出减少并发症、提高远期疗效的措施。方法:收集我院1990年1月～2002年9月采用吻合器行根治性前切除术直肠癌患者449例,严密随诊观察,用SPSS8.0软件统计分析。Logistic回归分析术后吻合口漏及复发的相关因素;寿命表法估计生存率,COX模型分析影响生存的因素。结果:本组术后发生吻合口漏11例,吻合口复发23例,5年生存率78.4%。年龄≥65岁或肿瘤周径≥半周,更易发生吻合口漏;术中输血是吻合口复发的原因之一,而影响生存的因素为病期与肿瘤分化程度。结论:用吻合器技术,可提高保肛率,安全易行。熟练掌握吻合器技术、术中注意处理直肠残端、保证肠管血运且无张力吻合,可减少吻合口漏的发生;同时,术中防止癌细胞扩散、强调TME原则和综合治疗等是提高疗效的有效措施。
BACKGROUND & OBJECTIVE: To preserve the anal function and improve the quality of life of patients, surgical resection of rectal cancer gradually presents the trend of replacing resection of abdominal perineum with anterior resection. Among them, the stapler technique provides a more reliable anastomosis for low resection of the anterior resection of the colon, expanding the indications for anterior resection. This study summarizes 449 cases of stapled colorectal cancer radical resection of the experience of surgery, put forward to reduce complications and improve long-term efficacy measures. Methods: A total of 449 cases of colorectal cancer undergoing radical anterior resection with stapler were collected from January 1990 to September 2002 in our hospital. The patients were followed closely and statistically analyzed by SPSS 8.0 software. Logistic regression analysis of postoperative anastomotic leakage and recurrence related factors; life table method to estimate the survival rate, COX model analysis of factors that affect survival. Results: There were 11 cases of anastomotic leakage in this group, 23 cases of anastomotic recurrence and 5-year survival rate of 78.4%. Age ≥ 65 years or tumor circumference ≥ half weeks, more prone to anastomotic leakage; intraoperative blood transfusion is one of the causes of anastomotic recurrence, and the factors that affect survival are the stage of disease and tumor differentiation. Conclusion: Stapler technology can improve the anal sphincter rate, safe and easy to operate. Proficiency in stapling technique, intraoperative attention to the treatment of rectal stump to ensure intestinal blood supply and tension-free anastomosis, can reduce the occurrence of anastomotic leakage; the same time, intraoperative prevention of cancer cell proliferation, emphasizing TME principles and comprehensive treatment is to improve the efficacy Effective measures.