Redmond H P, Austin O M, Clery A P, Deasy J M
Department of Surgery, Beaumont Hospital, Dublin, Ireland.
Br J Surg. 1993 Jul;80(7):924-7. doi: 10.1002/bjs.1800800746.
Clinical leakage of the anastomosis follows low anterior resection for rectal carcinoma in 5-10 per cent of patients despite standard stapling techniques. A modification of this method has obviated the need for a distal purse string. A flexible transverse stapling instrument (Roticulator 55) is applied across the rectum below the tumour, and a double-staggered row of staples is inserted as a substitute for the distal purse string. End-to-end stapled anastomosis is then performed with peranal insertion of a Premium CEEA stapling instrument. In 111 patients the indications for operation were colorectal carcinoma (96 patients), diverticulosis (ten), megarectum (four) and ulcerative proctocolitis (one). Three patients had clinical evidence of anastomotic leakage; all survived. The incidence of radiological leakage on Gastrografin enema 10-12 days after operation was 9 per cent. The perioperative mortality rate was 2 per cent; all deaths were from cardiovascular causes. Local recurrence of tumour occurred in eight patients (7 per cent) after a mean follow-up of 40 months. In conclusion, double-stapled end-to-end anastomosis has made low anterior resection for rectal carcinoma a safe procedure with a low mortality rate, an acceptable local recurrence rate and minimal (clinical) anastomotic leakage.
尽管采用了标准的吻合器技术，但直肠癌低位前切除术后仍有5%至10%的患者出现吻合口临床漏。对该方法的一种改进消除了使用远端荷包缝合线的必要性。使用一种可弯曲的横向吻合器（Roticulator 55）在肿瘤下方横跨直肠应用，并插入双排交错的吻合钉作为远端荷包缝合线的替代物。然后经肛门插入一台高级CEEA吻合器进行端端吻合。111例患者的手术指征为结直肠癌（96例）、憩室病（10例）、巨直肠（4例）和溃疡性直肠结肠炎（1例）。3例患者有吻合口漏的临床证据；均存活。术后10至12天行泛影葡胺灌肠造影显示漏出的发生率为9%。围手术期死亡率为2%；所有死亡均由心血管原因导致。平均随访40个月后，8例患者（7%）出现肿瘤局部复发。总之，双吻合器端端吻合使直肠癌低位前切除成为一种安全的手术，死亡率低，局部复发率可接受，且（临床）吻合口漏极少。
