Shimada S, Matsuda M, Uno K, Matsuzaki H, Murakami S, Ogawa M
Department of Surgery II, Kumamoto University Medical School, Japan.
Ann Surg. 1996 Nov;224(5):603-8. doi: 10.1097/00000658-199611000-00004.
A new device of staple cutter was developed to evaluate the clinical effect for the treatment of rectal stricture after the double stapling anastomosis.
The double stapling technique has become an established reconstruction method for patients with low anterior resection. The major complication of anastomotic stricture associated with circular stapling has been reported to be harmful and distressing. Because underlying mechanisms of stricture are not well understood, no prophylactic means have been developed and this results in postoperative dilation still being the only treatment available. Although various dilation methods are used for the treatment of stricture, none is fully satisfactory.
Low anterior resection was performed in 30 patients with rectal carcinoma using a double stapling technique. First, the incidence of the anastomotic stricture and the clinical factors that contribute to the stricture formation were studied. Second, the clinical effects and advantages of the treatment of coloproctostomic stricture using the newly developed device (staple cutter) were evaluated.
Nine (30%) of 30 patients had anastomotic stricture with the symptom of distressing frequent bowel movement. There was no significant relation between the clinical factors and the stricture when compared with that of nonstricture patients. Excellent dilation was performed in all of the nine strictures using the staple cutter, and the symptom of stricture disappeared dramatically in eight patients (89%) within 1 week. The recurrence of stricture occurred in two patients; however, it has not been observed after one further use of this treatment. The staple cutter is safe and easy to use even at the bedside, and except for a conventional anoscope, no special equipment, including fluoroscope, was needed.
From the significant effects and advantages, the procedure using staple cutter is recommended highly for the treatment of circular stapling anastomotic stricture of the rectum.
研发一种新型吻合器，以评估其治疗双吻合器吻合术后直肠狭窄的临床效果。
双吻合器技术已成为低位前切除术患者既定的重建方法。据报道，与圆形吻合器相关的吻合口狭窄这一主要并发症有害且令人痛苦。由于狭窄的潜在机制尚未完全了解，尚未开发出预防性手段，这导致术后扩张仍然是唯一可用的治疗方法。尽管使用了各种扩张方法来治疗狭窄，但没有一种方法能完全令人满意。
对30例直肠癌患者采用双吻合器技术行低位前切除术。首先，研究吻合口狭窄的发生率以及导致狭窄形成的临床因素。其次，评估使用新研发的器械（吻合器）治疗结直肠吻合口狭窄的临床效果和优势。
30例患者中有9例（30%）出现吻合口狭窄，伴有令人痛苦的排便频繁症状。与无狭窄患者相比，临床因素与狭窄之间无显著相关性。使用吻合器对所有9例狭窄进行了良好的扩张，8例患者（89%）的狭窄症状在1周内显著消失。2例患者出现狭窄复发；然而，再次使用这种治疗方法后未观察到复发。吻合器即使在床边使用也安全且易于操作，除了传统肛门镜外，不需要包括荧光镜在内的特殊设备。
鉴于显著的效果和优势，强烈推荐使用吻合器的方法来治疗直肠圆形吻合器吻合口狭窄。
