拖出式单、双吻合法在超低位直肠癌术中应用的比较研究

Comparison of double stapling technique and single stapling technique used in transanal pull-through rectal resection operations for ultra low rectal cancer

摘要:

目的：探讨拖出式单、双吻合术式在超低位直肠癌保肛术中应用的优缺点。方法：回顾我院胃肠外科2008年7月至2011年7月期间收治直肠癌患者共计1 138人，行拖出式吻合法超低位直肠前切术患者共113例，其中行拖出式双吻合器法保肛术（double stapling technique，DST）64例，行经肛门拖出单吻合器法保肛术（single stapling technique，SST）49例，分别统计：手术时间，术后发生并发症，如吻合口瘘、吻合口出血、吻合口狭窄的发生率，随访1~4年内盆底局部复发情况，住院时间及住院费用等，通过统计学分析探讨2种吻合方式的优缺点。结果：2组平均手术时间及术后平均住院时间差异无统计学意义（手术时间t=0.172，P=0.864；平均住院时间Z=-0.562，P=0.547）。术后并发症：其中吻合口瘘发生差异有统计学意义（χ2=6.592，P=0.01）；其他并发症情况差异无统计学意义（χ2=0.037，P=0.848）。局部复发：随访1~4年2组盆底局部复发差异无统计学意义（χ2=1.839，P=0.175）。平均住院费用2组差异有统计学意义（Z=-5.782，P=0.00）。结论：拖出式吻合法已成为超低位直肠癌保肛术常用术式，拖出式SST保肛术较拖出式DST保肛术具有操作简单、安全、费用更低、切除完整复发率较低等优势，在其适用范围内有有较大临床使用价值。

Abstract:

Objective：To study advantages and disadvantages of single stapling technique（SST） and double stapling technique（DST） in transanal pull-through rectal resection operations for ultra low rectal cancer. Methods：Totally 1 138 patients with rectal cancer were treated in our department from July 2008 to July 2011.One hundred and thirteen cases underwent transanal pull-through rectal resec－tion operations：49 cases by SST and 64 cases by DST. Operative time，postoperative complication incidences including anastomotic leakage，bleeding and stenosis，pelvic floor recurrence within 1-4 years，hospitalization duration and costs were analyzed and com－pared between the two groups. Advantages and disadvantages of the two stapling techniques were analyzed statistically. Results：Differ－ences in average operative time and postoperative hospitalization duration between the two groups were not statistically significant（op－erative time t=0.172，P=0.864；average hospitalization duration Z=-0.562，P=0.547）. Postoperative complications：differences in anas－tomotic leakage between the two groups were statistically significant（ χ2=6.592，P=0.01）；differences in other complications between the two groups were not statistically significant（ χ2=0.037，P=0.848）. Differences in pelvic floor local recurrence within 1-4 years between the two groups were not statistically significant （ χ2=1.839，P=0.175）. Differences in average hospital cost were statistically significant（Z=-5.782，P=0.00）. Conclusions：Transanal pull-through rectal resection has become a commonly used technique for ultra-low rectal cancer. With the advantages of simpler and safer manipulation，lower cost and recurrences and more complete resection，SST is superior to DST and is worthy of clinical application.