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APPLICATION OF DOUBLE STAPLING DEVICE IN LOW OR MIDDLE RECTAL CANCER

目的評價雙吻合器在中、低位直腸癌保肛手術應用中的安全性和實用性。方法分析 38 例應用雙吻合器行結、直腸吻合治療中、低位直腸癌的經驗。結果本組病例在使用雙吻合器中閉合和吻合過程順利、簡捷，術后無1 例發生吻合口漏; 發生吻合口狹窄1例,發生率為2.6%, 經肛門指法擴肛后即痊愈; 局部復發2例,復發率為5.3%。結論雙吻合器吻合法可作為中、低位直腸癌保肛手術的一種安全可靠的術式選擇。

DOMESTIC RELOADABLE STAPLERS FOR DOUBLE STAPLING TECHNIQUE IN ANTERIOR RESECTION OF RECTAL CARCINOMA

目的 探討應用國產吻合器行直腸癌前切除雙吻合器吻合術的可行性。方法 對38例直腸癌患者行前切除時，應用國產直線及管狀吻合器行雙吻合器吻合。結果 術后發生吻合口漏2例(5.3%)，1例可能與術后早期腹腔化療有關，另1例形成直腸陰道瘺。全組無吻合口狹窄。結論 國產吻合器在使用上雖不如進口一次性吻合器方便，但如果操作得當，技術熟練，仍可獲類似效果，其費用僅為進口吻合器的1/30。新的改進型中國產品應用更方便，更易使此技術推廣。

Evaluation of Circular Stapling Procedure for Aged Prolapse of Hemorrhoids

目的　探討吻合器痔上黏膜環形切除術（PPH）治療老年人(gt;65歲)重度痔的臨床療效。 方法　采用PPH治療21例老年人重度痔，其中Ⅲ度痔6例，Ⅳ度痔10例，嵌頓混合痔5例，對術后療效及并發癥的情況進行分析。結果　單純PPH手術4例（19.0%）,其余17例（81.0%）均行PPH結合其他手術。平均住院時間8 d，平均手術時間21.4 min。術后76.2%的患者痔核完全回縮，水腫消退。手術當天28.6%的患者疼痛需止痛處理。術后并發癥的發生以下腹部酸脹不適（57.1%）、尿潴留（28.6%）發生多見。平均隨訪21.3周，無肛門狹窄、大便失禁發生，無一例復發，便血5例（23.8%），均為便后少量出血。結論　PPH是適用于老年重度痔的理想術式。

Prevention and Treatment of Anastomotic Leakage after Applying Double Stapling Device in Sphincter Preserving Surgery（ Report of 81 Cases）

【摘要】目的評估雙吻合器在直腸癌保肛術中的應用價值，并探討吻合口漏等并發癥的防治措施。方法對81例采用雙吻合器行直腸癌前切除術患者的臨床資料進行回顧性分析。結果全組術中腫瘤切除后遠端直腸的縫合、吻合過程順利，手術時間120～190 min,平均160 min。術后發生吻合口漏3例（3.7%），吻合口狹窄1例（1.2%），無手術死亡。結論雙吻合器技術可幫助外科醫生順利完成直腸癌前切除術中結直腸的吻合，并且安全、可靠。

Treatment for Male Patients with Low Rectal Cancer by Means of Laparoscopic Total Mesorectal Excision and Per Anum Rectal Pull-Type of Anastomosis

Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.

Comparison of the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids combined with Block operation in treatment of obstructed defecation syndrome

Objective To explore the medium- and long-term clinical effects of procedure for prolapse and hemorrhoids (PPH) combined with Block operation for obstructed defecation syndrome (ODS). Methods Clinical data of 187 patients with ODS caused by rectocele (RE) who received PPH+Block operation or pure PPH operation in The Chaoyang City Central Hospital from Mar. 2011 to May. 2013, were collected retrospectively, in which 95 patients underwent PPH+Block operation (PPH+Block group) and 92 patients underwent PPH operation (PPH group). Compared the postoperative Longo’s score, postoperative clinical effect, operative effect, and recurrence rate between the 2 groups. Results ① The postoperative Longo’s score: the postoperative Longo’s scores of the PPH+Block group were both lower than those of the PPH group at 1- and 3-year after operation (P<0.05). ② Postoperative curative effect: the total effective rate of the PPH+Block group and the PPH group were both 100%, but the clinical effect of the the PPH+Block group was better than that of the PPH group (Z=–10.15, P<0.05). ③ Operative effect: there was no statistical significance on operative time, intraoperative blood loss, returned to normal activity time, hospital stay, and postoperative visual analogy score (VAS) between the 2 groups (P>0.05). In addition, there were no statistical significance on the incidences of urinary retention, hematochezia, exhaust anal incontinence, and anal fissure between the 2 groups (P>0.05), but the incidence of urgent or high anal straining feeling in the PPH+Block group was significantly higher than that of the PPH group (P<0.05). ④ Medium- and long-term recurrence rate: the recurrence rate of 1-year after operation was similar between these2 groups (P>0.05), but the recurrence rate of 3-year after operation in the PPH+Block group was significantly lower than that of the PPH group (P<0.05). Conclusions The medium clinical effect has no obvious difference between PPH+Block and PPH operation, but the long-term recurrence rate of the former is lower than that of the latter, and the medium- and long-term effect is stable in PPH+Block operation for ODS caused by RE.

Application of TME Combined with Dual Stapler Technique in 85 Cases With Low Rectal Cancer

目的:探討全直腸系膜切除術(total mesorectal excision,TME)結合雙吻合器(DST)治療低位直腸癌的效果及臨床價值。方法:對我院85 例低位直腸癌患者采用 TME和DST聯合治療的方法,觀察治療后的排便功能及療效.結果:所有患者手術均順利,無吻合口瘺和狹窄,切割環均完整,無手術閉合失敗及手術死亡。隨訪時間6 個月～5年,局部復發率4例(4.7%)。排便控制功能:優75 例(88.2%),良9 例(10.6%),差1 例(1.2%)。結論:TME和 DST聯用治療低位直腸癌,保肛效果滿意,并發癥少,提高了患者的生存質量,值得臨床推廣。

不規范使用管狀吻合器導致吻合口梗阻（附 40 例報道）

目的 探討胃腸外科手術中不規范使用管狀吻合器而導致吻合口梗阻發生的原因及預防對策。 方法 回顧性分析 2005 年 7 月至 2016 年 7 月期間于筆者所在醫院接受胃腸道手術且在術中使用管狀吻合器后發生吻合口梗阻的 40 例患者的臨床資料，分析患者的吻合口類型、梗阻發生部位、梗阻類型及梗阻發現時間及處理。 結果 ① 吻合口類型有：小腸端側吻合口 33 例，食管空腸端側吻合口 2 例，回腸結腸端側吻合口 3 例，結腸直腸端側吻合口 2 例。② 梗阻發生的部位：小腸吻合口梗阻 37 例，結腸吻合口梗阻 3 例。③ 梗阻類型有：完全梗阻 37 例，部分梗阻 3 例。④ 梗阻發現時間及處理：術中發現吻合口梗阻 35 例，及時進行重新吻合；術后發現吻合口梗阻 5 例，行二次手術重新吻合。 結論 若管狀吻合器使用不規范，吻合器桿插入腸腔向前移動時，會導致黏膜及黏膜下層在腸管內縱向滑動，對側的黏膜及黏膜下層被釘入吻合口，從而引起吻合口梗阻；精湛的吻合技術、大小合適的吻合器以及術后常規檢查吻合口是否通暢，均能有效地避免因吻合器使用不規范而導致的吻合口梗阻。

STARR—A Novel Therapy for The Treatment of Rectocele

Application of Round Stapler for Anterior Resection of Gastric Fundus and Cardia Cancer in Elderly Patients

目的 探討圓形吻合器在高齡賁門胃底癌經腹切除術中的應用。方法 回顧性分析1999年1月至2009年5月期間在我院接受圓形吻合器經腹切除術的238例70歲以上高齡賁門胃底癌患者的臨床資料，并對圍手術期結果進行分析。 結果 全組手術時間3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。術中并發大出血1例，給予積極止血，無術中死亡。所有病例機械吻合術后未出現吻合口漏。術后60例患者（25%）出現不同程度的并發癥，其中吻合口出血2例, 左側胸腔積液13例，肺部感染15例, 心衰3例, 肺不張2例, 心律失常10例，右側胸腔積液15例。無圍手術期死亡。術后隨訪3年，出現返流性食管炎45例，吻合口狹窄30例，無吻合口腫瘤復發，3年生存率為64%(152/238)。結論 應用圓形吻合器在高齡胃底賁門癌患者經腹切除術是安全、有效的。