Chiarugi M, Buccianti P, Sidoti F, Franceschi M, Goletti O, Cavina E
Department of Surgery, University of Pisa Medical School, Italy.
Acta Chir Belg. 1996 Feb;96(1):31-6.
Low anterior resection is commonly believed the main indication to double stapled (DS) technique, because placing the purse-string suture on the distal rectum is difficult or impossible. This study was designed to figure out the safety of the DS technique and to better define its role in rectal cancer surgery. The data of 34 patients that had a DS anastomosis were retrospectively compared to those of 43 that had a single-stapled (SS) anastomosis after anterior resection. Three deaths after SS (7%) and one after DS procedures (3%) were recorded (p = 0.62). Rates of clinical leaks were 12% (four cases) in the DS group and 14% (six cases) in the SS group (p = 0.41). The mean distance of the rectal tumour from the anal verge was significantly lower for DS (mean = 7.7 cm) respect to SS (mean = 12.7 cm) anastomoses (p < 0.0001) and the blood consumption at surgery was significantly greater in patients that had DS (mean = 375 ml) compared to SS-anastomoses (mean = 180 ml) (p = 0.028). Thus, the DS technique was mostly used in patients at high risk for leakage. The study shows that DS technique is a safe and reliable method to perform colorectal anastomosis after anterior resection for cancer. For cancers located in the upper rectum the routine adoption of the DS increases the cost of surgery and does not offer advantages over the SS technique with the exception of making feasible end-to-end mechanical anastomoses involving bowel segments having different diameters.
低位前切除术通常被认为是双吻合器（DS）技术的主要适应证，因为在直肠远端放置荷包缝线困难或无法进行。本研究旨在明确DS技术的安全性，并更好地界定其在直肠癌手术中的作用。对34例行DS吻合术的患者与43例行低位前切除术后单吻合器（SS）吻合术的患者的数据进行回顾性比较。记录到SS组术后有3例死亡（7%），DS组术后有1例死亡（3%）（p = 0.62）。DS组临床吻合口漏发生率为12%（4例），SS组为14%（6例）（p = 0.41）。与SS吻合术（平均12.7 cm）相比，DS吻合术的直肠肿瘤距肛缘的平均距离显著更低（平均7.7 cm）（p < 0.0001），且行DS手术患者的术中出血量（平均375 ml）显著多于行SS吻合术的患者（平均180 ml）（p = 0.028）。因此，DS技术主要用于吻合口漏高危患者。该研究表明，DS技术是直肠癌低位前切除术后进行结直肠吻合的一种安全可靠的方法。对于位于直肠上段的癌症，常规采用DS技术会增加手术成本，且除了能使不同直径肠段之间进行端对端机械吻合成为可能外，与SS技术相比并无优势。
