Ho Y H, Tan M, Leong A, Eu K W, Nyam D, Seow-Choen F
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Dis Colon Rectum. 1999 Jan;42(1):89-95. doi: 10.1007/BF02235189.
The significance of anal sphincter injury from transanal inserted staplers was studied. A randomized, controlled comparison was made of anorectal manometry and clinical function after sigmoid colectomy (avoiding nerve injury from rectal mobilization), anastomosed by either transanal inserted stapler or biofragmentable anastomotic ring (avoiding anal manipulation).
Fifty-eight consecutive patients with sigmoid adenocarcinoma were randomly assigned to transanal inserted stapler or biofragmentable anastomotic ring groups. Anorectal manometry and clinical bowel function assessment were performed by an independent blinded observer before surgery and six weeks and six months after surgery.
At six weeks after surgery, there was significant impairment of mean anal resting pressures (mean impairment, 23 percent; P < 0.001) and physiologic anal length (mean impairment, 31 percent; P < 0.01) in the transanal inserted stapler group (27 completed the trial), but not in the biofragmentable anastomotic ring group (18 completed the trial). Pressures remained impaired at six months. When changes in the anal pressures were compared between groups, the mean anal resting pressure (P < 0.001) and maximum squeeze pressure (P < 0.01) at six weeks and mean anal resting pressure at six months (P < 0.01) were significantly more impaired in the transanal inserted stapler group. Postoperative bowel function was not different between the two groups. Postoperative complications were similar. In the transanal inserted stapler group one patient died of anastomotic leak sepsis and one had wound infection; in the biofragmentable anastomotic ring group one patient died of myocardial infarct and one had wound infection.
Direct injuries to the internal anal sphincter occurred after transanal inserted stapler but not biofragmentable anastomotic ring anastomoses. Clinical function was not correspondingly affected, probably because of the adequate residual rectal reservoir after sigmoid colectomy.
研究经肛门插入吻合器导致肛门括约肌损伤的意义。对乙状结肠切除术后（避免直肠游离造成神经损伤）采用经肛门插入吻合器或生物可降解吻合环（避免肛门操作）进行吻合后的肛门直肠测压和临床功能进行了随机对照比较。
58例连续性乙状结肠癌患者被随机分为经肛门插入吻合器组或生物可降解吻合环组。由一名独立的盲法观察者在手术前、术后6周和6个月进行肛门直肠测压和临床肠功能评估。
术后6周，经肛门插入吻合器组（27例完成试验）平均肛门静息压显著受损（平均受损23%；P<0.001），生理肛管长度也显著受损（平均受损31%；P<0.01），而生物可降解吻合环组（18例完成试验）则未出现这种情况。6个月时压力仍受损。比较两组肛门压力变化时，经肛门插入吻合器组术后6周的平均肛门静息压（P<0.001）和最大收缩压（P<0.01）以及术后6个月的平均肛门静息压（P<0.01）受损更显著。两组术后肠功能无差异。术后并发症相似。经肛门插入吻合器组1例患者死于吻合口漏败血症，1例发生伤口感染；生物可降解吻合环组1例患者死于心肌梗死，1例发生伤口感染。
经肛门插入吻合器吻合后发生了对内括约肌的直接损伤，而生物可降解吻合环吻合后未出现这种情况。临床功能未受到相应影响，可能是因为乙状结肠切除术后直肠贮袋残留充足。
