关键词: 中低位直肠癌, 直肠低位双吻合, 垂直切割闭合, 术后并发症

Abstract:

Background and purpose: Anastomotic leakage and low anterior resection syndrome(LARS) are both common complications in dual-anastomosis for patients with low rectal cancer. The aim of this study was to observe and explore the significance and role of vertical cutting of the closed distal rectum in dual-anastomosis for patients with low rectal cancer. Methods: A total number of 120 patients with mid-low rectal cancer who admitted to and completed laparoscopic rectal cancer resection in the Department of General Surgery, the First Affiliated Hospital of Soochow University from Feb. 2010 to Jun. 2014 were pair-matched into Groups A and B based on their gender, age, tumor size, the distance of lower edge to the dentate line and tumor staging, etc. For the 55 patients in Group A (observation group), the rectum distal end was closed vertically instead of horizontally while disposing “the first intestinal anastomosis”, intestine-intestine anastomosis was conducted in an “end-corner” approach when dealing with “the second intestinal anastomosis”, upper corner (“dog ear”) of the closed line in the distal end of the rectum was removed, the lower corner (“dog ear”) of the closed line in the distal end of the rectum was removed using vascular occlusion clamp method, and the T-shaped interchanges (“dangerous triangle”) of stapled sutures formed after anastomosis were strengthened with absorbable suture. For the 65 patients in Group B (control group), laparoscopic dual anastomosis was conducted using conventional method, and the two “dog-ears” and “dangerous triangles” were kept without any treatment. The clinical outcomes of the two groups of patients were analyzed retrospectively.Results: In group A, It was convenient to complete the operation when the “dog ears” and “dangerous triangle” on the vertical line after cutting the closed distal rectum vertically by “end-corner” anastomosis. The axis of intestine formed a certain angle making the closed distal rectum into “ampulla” sample without “dog ears”. the “dangerous triangle” were strengthened with absorbable suture. In group B, The distal and proximal intestine located on the same axis after intestine-intestine anastomosis leaving two “dog ears” and a “dangerous triangle”. The general clinical data of patients in the two groups were comparable and not significantly different (P>0.05). The two groups of patients showed no significant differences in blood loss, postoperative drainage, postoperative anastomotic bleeding, anal exhaust time, and length of hospital stay (P>0.05). However, the operation time as well as the numbers of anastomotic fistula occurrence, defecation, tenesmus and post-operation re-ostomy differed significantly (P<0.05). Conclusion: Vertical cutting of the closed distal rectum with dual anastomosis made the “new” intestine closer to the physiological bending and morphology of the rectum, meanwhile, it simplified the approach of removing “dog ear” and strengthening “dangerous triangle”, finally it significantly reduced the incidence of post-surgical complications.

Key words:

margin: 0cm 0cm 0pt, text-autospace: , mso-layout-grid-align: none" align="left">font-family: "TimesNewRomanPSMT",serif, mso-bidi-font-family: TimesNewRomanPSMT, mso-font-kerning: 0pt, mso-hansi-font-family: Calibri, mso-hansi-theme-font: minor-latin">Mid-low rectal cancer, Dual anastomosis for low rectal cancer, Vertical cutting of the closed distal rectum, Post-operation complications