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近10年来,由于订书机吻合器的广泛使用,尤其是双吻合器在临床上的使用,使保肛手术成功率达69.83％,但仍有一部分低位直肠癌需行Miles术。1990年1月至1997年12月,选择了23例低位直肠癌经腹切除、结肛吻合术。结果:根治切除22例,占95.65％,无手术死亡病例,结肛吻合口瘘发生2例,占8.69％,随访6～72个月,平均42个月,盆腔复发2例,占8.69％,无吻合口复发及吻合口狭窄。手术后近期肛门控制稀便功能欠佳,3～6个月随访肛门功能良好。结论:结肛吻合虽有一定难度,但手术安全、并发症低、符合直肠癌根治要求,是一种理想的保肛术式。
In the past 10 years, due to the extensive use of stapler staplers, especially the use of double staplers in clinical practice, the success rate of sphincter preserving surgery has reached 69.83%. However, some low rectal cancers still require Miles surgery. From January 1990 to December 1997, 23 cases of low rectal cancer undergoing abdominal resection and anal collateral anastomosis were selected. RESULTS: 22 cases (95.65%) were treated by radical resection and no operation death occurred. Anastomotic fistula occurred in 2 cases (8.69%). The follow-up ranged from 6 to 72 months (mean 42 months). Pelvic recurrence occurred in 2 cases (8.69%). No anastomotic recurrence and anastomotic stenosis. Short-term anal control of loose stools after surgery was poor, with good anal function at 3 to 6 months of follow-up. Conclusion: Although the anastomosis of the anal canal is difficult, it is an ideal sphincter-saving procedure because of its safe operation, low complications, and the requirement of rectal cancer.