文档介绍：低位直肠癌经肛门直结肠外翻拉出保留肛门吻合术
【摘要】目的探讨低位直肠癌保留肛门括约肌功能的手术方法和手术适应证。方法对低位直肠癌经腹经肛门直结肠外翻拉出保留肛门吻合术15例。结果全组无手术死亡,未发生吻合口漏和吻合口狭窄,局部复发1例,20周左右恢复正常排便排气功能,无大便失禁病例。随访8个月~5年,5例为远处转移,死亡4例,其中1例肝转移3年仍生存。结论根据直肠癌的临床分期和肿瘤的生物学特性选择保肛手术适应证,经腹、肛门齿线上直肠癌根治性切除,行肛门直结肠外翻拉出吻合是低位直肠癌较好的保肛术式。
【关键词】低位直肠癌;保肛手术
[Abstract] Objective To investigate anus sphincter preserved surgical method and indication for loosis through No patients died of operation,no patients osis,no defecation incontinence happened after postoperative 20 onths to 5 years,5 cases etastasis,4 of these died,one of these had lived etastasis for 3 The indication of anus preserved operation should be chosen according to clinical stage and biological characteristic of rectal malignancy; eversion and pull-through anus preserved colorectal anastomosis through anus is a better anus preserved operation for lo。病理分型:腺癌10例,黏液腺癌5例。肿瘤形态:溃疡型8例,肿块型4例,浸润型3例。肿瘤侵犯直肠壁1/2周8例,1/4周5例,3/4周2例。分期:A2期5例、B期7例、C1期2例、C2期1例。
手术方法术前准备及麻醉方法同传统的直肠癌根治术。患者置于会阴截石位,做下腹部正中切口,如需要可绕脐适当延长切口。进腹后于乙状结肠直肠交界处上缘10 cm以上用纱布条结扎肠管,于结扎处下部向肠腔内注入5-FU 500 mg。为了保证左半结肠足够的长度以便拉下在肛门外吻合和血液供应,根据乙状结肠的长短选择结扎肠系膜下动静脉部位。在直视下用电刀或超声刀沿盆腔脏层、壁层筋膜之间将左右腹腔下神经内侧的脏层筋膜、肿块及直肠周围系膜完全游离,直达会阴体。将直肠全周从耻骨直肠肌及肛门外括约肌的上缘游离。将直肠充分游离后,暂不切断直肠,在距直肠肿瘤上缘15 cm左右切断结肠,用一长血管钳从肛门插入直肠至结肠断端并夹住结肠,向肛门外拉血管钳使直、结肠经肛门充分外翻,并稍用力向外牵拉,在充分暴露直视下距肿瘤下缘3 cm以上的齿状线处切断直肠,边切边用4~6把组织钳夹住固定断端防止回缩。同法将近端结肠经直肠断端拖至肛门外,并注意防止结肠扭转,先分别在上、下、左、