摘要目的 总结分析早期低位直肠癌经腹肛门拖出切除双吻合器吻合I临床应用的经验体会.方法 对2001年5月至2008年3月25例早期低位直肠癌采用经腹直肠游离,远端直肠腔内翻转经肛门拖出、直视下切除,双吻合器吻合.其中男性17例,女性8例,平均年龄45岁(26～57岁).肿瘤下缘距齿线的平均距离为(3.2 ±0.5)cm(2.0～4.5 cm),肿瘤平均最大直径为(2.8±0.8)cm(2.0～3.5 cm).结果 肿瘤下缘距切缘的平均距离为(1. 5±0.4)cm(1.1～2.2 cm),切缘肿瘤均阴性.吻合口位于齿状线以上18例,距离0.3～2.1 cm[(1.7±0.2)cm],7例吻合口位于齿状线以下0.1～0.5 cm(平均0.3 cm).一例术后吻合口漏,保守治疗愈合.术后随访6～62个月(平均32个月),局部复发1例(4.0%),远处肝脏转移3例(12.0%);肺部转移2例(8.0%).轻度大便失禁7例.结论 对于早期低位早期直肠癌的切除,与经腹在盆腔内离断相比,将直肠经肛门翻出在直视下离断可以更准确地把握切断的位置,既保证安全的切除距离,又尽可能地多保留远端直肠,保留控便功能.

abstractsObjecitve To introduce the experiences of pull-through transection and double stapling anastomosis for early lower rectal Cancer.Methods From May 2001 to March 2008,25 patients with early stage lower rectal cancer were operated by using pull-through transection and double stapling anastomosis.The average distance between the dentate line and lower margin of the tumor is(3.2±0.5)cm(2.0-4.5cm).The average tumor diameter is(2.8±0.8)cm(2.0-3.5 cm).Results The average distance between the lower margin of the tumor and transection line is(1.5 ±0.4)cm(1.1-2.2 cm).All the resection margins were negative.Eighteen cases of the anastomosis were above the dentate line,0.3-2.1 cm[(1.7±0.2)cm]and the other 7 were below,0.1-0.5 cm(average 0.3 cm).Anastomotic leakage occurred in l case.and cured with conservative treatment.Local recurrence occurred in 1 case(4.0%),liver metastasis in 3(12.0%)and lung metastasis in 2(8.0%),respectively.Mild fecal incontinence occurred in 7 cases.Conclusion Compared with trans-abdomihal transection of distal rectum in low anterior resection of rectal cancer,pull-through transection and anastomosis provides more precise control of the cutting line and simpler resection.