Sugarbaker P H
Department of Surgical Oncology, Washington Cancer Institute, Washington Hospital Center, Washington, D.C. 20010, USA.
J Surg Oncol. 1996 Feb;61(2):155-8. doi: 10.1002/(SICI)1096-9098(199602)61:2<155::AID-JSO12>3.0.CO;2-8.
Low anastomosis using a circular stapling instrument has become standard for performing a colorectal reconstruction following resection of a rectal cancer. Often these anastomoses are performed deep in the pelvis using a circular stapling instrument without clear visualization of the anastomotic site. In the female patient, unless an adequate stump of rectum is left above the circular staple line, there is danger that the side wall of the posterior aspect of the vagina can be included in the tissue rings (donuts) that are resected by the circular stapling instrument. This leaves the patient at high risk for late development of a rectovaginal fistula by vaginal mucosa being incorporated into the rectal wall. Maintenance of an adequate mucosa beyond the linear staple linen and a vaginal examination prior to firing the circular stapler will prevent this problem. A patient is presented and the technical details for a safe low-low colorectal anastomosis are reviewed.
使用圆形吻合器进行低位吻合已成为直肠癌切除术后结直肠重建的标准术式。通常，这些吻合术是在盆腔深处使用圆形吻合器进行的，吻合部位无法清晰可视。在女性患者中，除非在圆形吻合器线以上保留足够长度的直肠残端，否则存在阴道后壁侧壁被圆形吻合器切除的组织环（“甜甜圈”）包含的风险。这会使患者因阴道黏膜并入直肠壁而面临后期发生直肠阴道瘘的高风险。在直线吻合器线以外保留足够的黏膜，并在击发圆形吻合器之前进行阴道检查可预防此问题。现介绍一例患者，并回顾安全的低位结直肠吻合术的技术细节。
