目的探讨痔切除吻合器痔上粘膜环切术（PPH）的临床应用价值。方法采用33 mm痔切除吻合器痔上粘膜切除术对严重脱垂性痔30例进行治疗。结果全组病例平均手术时间10分钟，术后住院时间1～3天，脱出痔块均回缩，切除直肠粘膜完整率达98%，术后90%的患者无肛门疼痛，随访3个月，28例满意，2例基本满意。结论采用痔切除吻合器痔上粘膜环切术治疗严重脱垂性痔是一种新技术，其手术操作简单，具有安全、有效、手术时间短、术后疼痛轻、恢复快等特点，有望替代传统的治疗方法。
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
目的:评价双吻合器技术在超低位直肠癌保肛术中的实用性。方法:回顾分析我院2006年1月至2009年11月60例超低位直肠癌应用双吻合器技术保肛的临床资料。结果:本组手术中结直肠56例吻合顺利,术后1例吻合口瘘及无出血病例发生,吻合口狭窄2例(333％),无手术死亡病例。结论:应用双吻合器技术可极大提高超低位直肠癌保肛率且并发症少,值得推广。
Objective To evaluate the effect of mechanical suture in surgery of esophageal carcinoma,Methods Five hundred and sixty-eight cases of esophagogastrostomy and esophagojejunostomy for esophageal and cardiac carcinoma were collected in our hospital between January, 1988 and December, 2002. They were devided into two groups according to the methods of anastomoses, the group by stapler and the group with hand. The incidence of postoperative complications in the two groups was compared. Results The time of esophagogastrostomy, the total operating time, and postoperative fasting time of group by stapler were shorter than those of group with hand （Plt;0. 01）, and there was no statistically difference in the median hospitalized time after operation for two groups. The anastomotic leakage, anastomotic stricture, anastomotic bleeding , incidence of postoperative complications in respiration and circulation and mortality rate of group by stapler were lowed than those of group with hand （2.1%, 1.4%,0%,2.8% and 0.7% vs.6.8%,4.3%,1.4%,16.5% and 2.9%）. There was no statistical difference in the postoperative gastro-esophageal reflux for two groups （P 〉 0.05 ）. Conclusion The median time of esophagogastrostomy and the median operating time by stapler are decreased and the incidence of postoperative complications is decreased.
目的 观察经肛门吻合器直肠部分切除吻合术（stapler transanal partial resection of rectum，STAPRE）治疗直肠脱垂的临床疗效。方法 笔者所在医院2005年8月至2011年2月期间对长度小于15cm的42例直肠脱垂患者行STAPRE治疗。结果 术后随访12个月者36例（其中19例超过24个月），随访6个月者6例，均未见复发。结论 STAPRE适合Ⅰ、Ⅱ及Ⅲ度直肠脱垂以及年迈和全身状况不佳的患者，可消除开腹手术带来的风险。
ObjectiveTo compare the safety and efficacy of powered anastomosis versus mechanical anastomosis in gastrointestinal surgery. MethodsComputerized searches were conducted in PubMed, EMbase, Web of Science, CNKI, and CBM databases to collect studies comparing the safety and efficacy of powered versus mechanical anastomosis in gastrointestinal surgery. The search period was from the inception of each database to March 2025. Literature was screened according to inclusion and exclusion criteria, data were extracted, and the risk of bias was assessed. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using the Metan package in Stata/MP 17.0 software. ResultsA total of 15 observational studies (13 retrospective and 2 prospective) involving 21,424 patients were finally included, with 9 823 patients in the experimental group (powered anastomosis) and 11 601 patients in the control group (mechanical anastomosis). The NOS scores of all included studies were ≥5 points. Meta-analysis results showed that, compared to the mechanical anastomosis group, the powered anastomosis group had significantly lower incidence rates of anastomotic leakage [RR=0.60, 95%CI (0.37, 0.96), P=0.031], postoperative complications [RR=0.68, 95%CI (0.53, 0.86), P<0.01], intraoperative bleeding rate [RR=0.29, 95%CI (0.15, 0.56), P<0.01], and 30-day readmission rate [RR=0.62, 95%CI (0.39, 0.97), P<0.05]. No statistically significant differences were found in anastomotic stenosis [RR=0.53, 95%CI (0.18, 1.57), P=0.25], intraoperative blood loss [SMD=−0.03, 95%CI (−0.15, 0.08), P=0.57], operation time [SMD=−0.00, 95%CI (−0.08, 0.07), P=0.90], or postoperative hospital stay [SMD=−0.05, 95%CI (−0.13, 0.02), P=0.15]. ConclusionIn gastrointestinal surgery, powered anastomosis may offer potential advantages over traditional mechanical anastomosis in improving the aforementioned safety and efficacy outcomes.
目的 探讨在局部麻醉下行痔上黏膜环形切除钉合术（procedure for prolapse and hemorrhoids，PPH）治疗重度内痔的可行性及临床应用价值。方法 笔者所在医院科室从2005年起对32例Ⅲ度及Ⅳ度脱垂性内痔（含1例混合痔）患者均采用苯巴比妥＋氢溴酸东莨菪碱＋利多卡因肛管直肠环形局部浸润麻醉行PPH术，对其麻醉效果、手术时间、术中及术后疼痛、尿潴留、术后感染、肛门狭窄、住院时间、治疗满意度等进行分析。结果 32例患者均顺利完成手术，有1例术中改行低位连续硬膜外麻醉，1例辅加镇静剂及镇痛剂。术后28例对疼痛能耐受，4例需镇痛药物；1例患者有肛门坠胀感；所有患者伤口均一期愈合，无尿潴留、术后感染、出血、肛门狭窄等并发症发生；31例对疗效满意，有1例感肛门坠胀，行温水坐浴及痔疮膏纳肛治疗1周后缓解。住院时间3～6d，平均4d。32例患者均进行有效随访，随访时间2～4个月，平均3个月，无大便失禁或复发，肛门控便能力均可。结论 局部麻醉下行PPH术治疗重度内痔是一种安全可行的手术方法，麻醉操作护理简单，疗效确切，术后并发症少，术后恢复快，并可减少医疗费用。
ObjectiveTo explore the application effects of hand-sewn layered anastomosis (HS) and circular stapled anastomosis (CS) in inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer. MethodsPatients who underwent inflatable mediastinal mirror synchronous laparoscopic radical esophagectomy for esophageal cancer in Huaihe Hospital of Henan University from 2018 to 2019 were retrospectively included. Patients were divided into a HS group and a CS group according to the anastomosis methods, and propensity score matching was used to match patients at a ratio of 1:1. The baseline clinical characteristics, perioperative indicators, CD4+/CD8+ immune index comparison, pain, various lung function indicators, incidence of short-term and long-term postoperative complications, and quality of life were compared between the two groups. ResultsA total of 153 patients were included, including 108 males and 45 females, with an average age of (61.81±5.18) years. After propensity score matching, 70 patients were included in each group. Compared with the CS group, the operation time was longer in the HS group [(107.10±8.25) min vs. (97.65±6.85) min, P<0.001]; the CD4+/CD8+ level was lower in the HS group 1-3 days after surgery; the pain score was higher, and various lung function indicators (forced expiratory volume in the first second, forced vital capacity, and one-second rate) were lower in the HS group 1-7 days after surgery; within 6 months after surgery, the incidence of anastomosis-related complications (anastomotic stenosis, anastomotic fistula, and gastroesophageal reflux) was lower in the HS group; and the quality of life score was higher in the HS group from 14 days to 6 months after surgery (P<0.05). ConclusionHS can reduce the incidence of postoperative anastomotic fistula, anastomotic stenosis, and gastroesophageal reflux, and improve the short-term quality of life of patients, but it has a longer operation time, more intense short-term postoperative pain, and may affect the early recovery of lung function. HS and CS are complementary, and the appropriate surgical method should be chosen according to the individual situation of the patient to achieve the maximum clinical benefit.
Compared to traditional suturing, lung stapling using automatic staplers offers advantages such as smaller trauma, faster wound healing, ease of operation, and lower complication rates, making it widely used in clinical practice. However, there are significant differences in bronchial tissue thickness at different anatomical locations, and the market is flooded with various types of staplers. Currently, there is a lack of recommended stapling schemes for bronchial staplers at different anatomical locations. This article reviews the development and application of automatic staplers and summarizes some types of staplers that are currently used in clinical practice, with the aim of promoting the formation of individualized stapler selection protocols for minimally invasive thoracic surgery based on the Chinese population.