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目的介绍在全直肠系膜切除基础上用支撑捆扎法完成低位直肠癌低位或超低位结肠-直肠(肛管)吻合手术术式。方法对346例低位直肠癌在全直肠系膜切除和根治性清扫基础上,用支撑捆扎法进行保留肛门括约肌手术,对直肠断端距齿状线≥1cm者用改良Welch手术完成结肠-直肠吻合术;直肠断端距齿状线≤1cm者行保留肛门内括约肌的结肠-肛管吻合术。结果本组346例手术中无死亡病例,术后近期出现吻合口漏4例(1·2%),局部引流2周治愈2例、横结肠造口转流2例,无吻合口出血。吻合口距离齿状线距离:2~3cm者114例,1~2cm者145例,0~1cm者87例。术后吻合口狭窄10例,狭窄率2·9%。Lifetable法计算5年生存率和局部复发率分别为78·6%及6·3%。手术后3个月排便功能的优良率为82·6%。结论支撑捆扎法用于低位直肠癌保肛手术可以完成耻骨直肠肌上缘到肌间沟平面的吻合,吻合口漏和吻合口狭窄发生率较低。
OBJECTIVE: To describe the technique of anastomosis of lower rectum or ultralow colo-rectum (anal canal) on the basis of total mesorectal excision with support and strapping method. Methods 346 cases of low rectal cancer on the basis of total mesorectal excision and radical radical mastectomy with the retention of anal sphincter surgery, rectal stump distance denture ≥ 1cm with modified Welch operation to complete the colon - rectal anastomosis ; Rectal ends away from the dentate line ≤ 1cm line to retain the anal sphincter colon - anal anastomosis. Results There were no deaths in 346 cases. There were 4 cases (1.2%) of anastomotic leakage recently, 2 cases of local drainage in 2 weeks, 2 cases of transverse colostomy, and no anastomotic bleeding. Anastomosis from the dentate line distance: 2 ~ 3cm 114 cases, 1 ~ 2cm 145 cases, 0 ~ 1cm 87 cases. Anastomotic stenosis in 10 cases, the stenosis rate of 2.9%. The 5-year survival and local recurrence rates calculated by the Lifetable method were 78.6% and 6.3%, respectively. The excellent and good rate of defecation function at 3 months after operation was 82.6%. Conclusion Support strapping method for low rectal cancer anal sphincter preservation surgery can be done on the edge of the puborectalis muscle to the anastomosis between the plane, anastomotic leakage and anastomotic stenosis lower incidence.