Ti T K, Rauff A, Goh H S
Aust N Z J Surg. 1986 Dec;56(12):919-22. doi: 10.1111/j.1445-2197.1986.tb01855.x.
The circular stapler was used for colorectal anastomosis in 38 patients (rectal carcinoma 37 cases, sigmoid diverticulitis one case). In Singapore Chinese patients, the most commonly used cartridge size was the EEA 28 mm and ILS 29 mm. The incidence of clinical anastomotic leakage in patients with complete resection rings was 10% (three leaks in 32 patients), leakage occurring only amongst the 24 patients who had resection of a tumour 6-9 cm from the anal verge. Significant, though easily dilatable, stenosis occurred in three patients (8%), and was associated with rectal membrane formation in two patients. Local recurrence, occurring in seven patients in a 0.5-3 year follow-up period was associated with Dukes' C disease; two recurrences occurred in four patients in whom the distal bowel clearance was less than 1.5 cm. The circular stapler facilitates sphincter conservation in mid-rectal cancer and its use in low anterior resection is justifiable when performed with a distal bowel clearance of 2 cm and complete excision of pararectal tissue above the pelvic floor muscles.
38例患者（37例直肠癌，1例乙状结肠憩室炎）使用圆形吻合器进行结直肠吻合。在新加坡华裔患者中，最常用的钉仓尺寸是EEA 28mm和ILS 29mm。有完整切除环的患者临床吻合口漏发生率为10%（32例患者中有3例漏），漏仅发生在距肛缘6 - 9cm处肿瘤切除的24例患者中。3例患者（8%）出现明显但易于扩张的狭窄，其中2例与直肠膜形成有关。在0.5 - 3年的随访期内，7例患者出现局部复发，与Dukes' C期疾病有关；4例远端肠管切缘小于1.5cm的患者中有2例复发。圆形吻合器有助于保留直肠中段癌的括约肌，当远端肠管切缘为2cm且完全切除盆底肌肉上方的直肠旁组织时，在低位前切除术中使用圆形吻合器是合理的。
