摘要
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: Currently, to preserve the anal function an d improve the patients' quality of life, low anterior resection has become the p referred option in curative rectal cancer surgery. As the use of stapling instru ments provides more reliable anastomoses in low anterior resection for rectal ca ncer, it enlarges the indication of this procedure. The aim of this study was to review the operation results and their outcomes of 449 rectal cancer patients w ho recieved of curative low anterior resections with stapling devices, and inten t to find some measures that can reduce complications and improve long-term eff ects of this procedure. METHODS: The study included 449 patients who had a poten tially curative anterior resection with stapled anastomosis in rectal cancer bet ween Jan.1990 and Sept. 2002 at Sun Yat-sen University Cancer Center. All patie nts had complete follow-up data. All data were analyzed by SPSS8.0 software, ri sk factors for anastomotic leakage and recurrence were analyzed by Logistic regr ession, survival was analyzed by life table, and prognostic factors were screene d by multivariate COX model. RESULTS: There were 11 cases of anastomotic leakage and 23 cases of anastomotic recurrence after operation. The 5-year survival ra te was 78.4%. Age of ≥65 years, and tumor involvement of more than half circum ference were risk factors for anastomotic leakage, blood transfusion during oper ation was the risk factor for anastomotic recurrence. The independent factors fo r poor survival were stage of disease and tumor differentiation. CONCLUSIONS: St apling devices can improve the anal reservation rate in low rectal cancer surger y, and stapled anastomoses is safe and feasible. Adequate preparation of bowel e nds, a tension-free anastomosis with excellent blood supply and skilled stapled anastomoses were key measures to reduce anastomotic leakage, While TME, multidi sciplinary therapy and the principle of avoiding medical spread, were key measur es to improve treatment effect of rectal cancer.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2004年第z1期1508-1511,共4页
Chinese Journal of Cancer
关键词
结直肠肿瘤
吻合器
并发症
生存率
Colorectal neoplasm
Stapling devices
Complications
Survival rate
