目的:探讨中低位直肠癌前切除术保肛的临床应用价值及术中放置引流支架管对吻合口漏的预防作用.方法:对本科2006年1月～2009年1月中低位直肠癌32例行低位前切除术保肛,采用单吻合技术借助辅助手段,吻合保肛成功.吻合后经肛放置大口径肛管经吻合口向上插入至吻合口上方10 ～20 cm处肠管,起到支架及引流目的.结果:该组32例均顺利完成吻合.术中2例发现吻合口缺损,给予即刻修补.术后无一例发生吻合口漏.术后吻合口狭窄2例,扩肛后痊愈.本组患者术后3个月排便功能恢复正常.随访3 ～44个月局部复发2例,后行经腹会阴联合切除术.结论:中低位直肠癌采用单吻合技术借助辅助手段可完成吻合,方法简单.术后肠腔内放置大口径支架引流管对吻合口漏有较好的预防作用.%Objective: To asses the clinical significance of Dixon operation with sphincter-sparing procedure and placement of drainage system for preventing anastomosis leakage in mid-low rectal cancer by lower anterior resection. Methods: Between Jan 2006 and 2009, we performed lower anterior resection in 32 patients with rectal cancer by single-stapling technique with adjuvant therapy that led to successful sphincter preservation. Ater anastomosis, the large-sized artificial rectal tube in diameter was placed through anus to distal anastomosis 10 ～20 cm above as framework and drainage. Results: Totally, the anastomosis was successfully conducted in the 32 cases. Though anastomotic defect was found in 2, it was managed instantly. No postoperative anastomotic leakage occurred in a single case. Narrowed anastomosis was seen in 2 cases, which were cured by dilation of the anus. Bowel movement was returned to normal for the total 32 cases 3 months after the procedure. The follow-up during 3 to 44 months showed 2 cases of relapse, yet, they were managed by abdominal perineal resection. Conclusion:Single-stapling technique with adjuvant therapy may facilitate the anastomosis in mid-low rectal cancer after lower anterior resection. The technique is easy in performance, and largesized drainage tube in diameter planted through anus can prevent the stoma from leakage.
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