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目的探讨国产圆形吻合器在中低位直肠癌保肛术治疗中的可行性和安全性。方法对107例中低位直肠癌经腹肛门根治性切除行国产圆形吻合器吻合保肛术进行回顾性临床分析。107例患者中男62例,女45例。年龄27~99岁,平均为57.9岁。肿瘤下缘距齿状线5~8 cm。病理诊断直肠腺癌103例,其中高分化者37例,中分化者55例,低分化者11例。腺瘤癌变4例。Dukes分期:A期29例,B期57例,C期17例,D期4例。结果术后随访率为85.9%(92/107),中位随访时间为46个月。术后发生吻合口瘘4例(3.7%),吻合口狭窄3例(2.8%),术后12~24周时排便功能基本恢复到正常。术后局部复发率为6.5%(6/92),肝转移率为13.0%(12/92),术后总体的5年生存率为66.6%(32/48)。结论国产圆形吻合器在低位直肠癌保肛术的应用,其性能和安全行与进口吻合器无大的区别,更实用于经济条件较差的患者。
Objective To investigate the feasibility and safety of domestically made circular staplers in the treatment of anal sphincter of low and middle rectal cancer. Methods Retrospective clinical analysis of 107 cases of low and middle rectal cancer transabdominal anal resection line domestication anastomosis. Among the 107 patients, 62 were male and 45 were female. Aged 27 to 99 years old, with an average of 57.9 years old. Tumor margin from dentate line 5 ~ 8 cm. Pathological diagnosis of rectal adenocarcinoma 103 cases, including 37 cases of well-differentiated, moderately differentiated in 55 cases, poorly differentiated in 11 cases. Adenoma carcinogenesis in 4 cases. Dukes staging: A in 29 cases, B in 57 cases, C in 17 cases, D in 4 cases. Results The follow-up rate was 85.9% (92/107) and the median follow-up time was 46 months. Anastomotic fistula occurred in 4 cases (3.7%) and anastomotic stenosis in 3 cases (2.8%). The defecation function returned to normal after 12 to 24 weeks. The postoperative local recurrence rate was 6.5% (6/92), liver metastasis rate was 13.0% (12/92), and postoperative overall 5-year survival rate was 66.6% (32/48). Conclusion Domestic round stapler in low rectal cancer anal sphincter, its performance and safety of the import stapler with no big difference, more practical for patients with poor economic conditions.