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.
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 compare the curative effect of procedure for prolapse and hemorrhoids (PPH) with MilliganMorgan hemorrhoidectomy (MMH) for acute incarcerated hemorrhoids. Methods A retrospective study of 103 patients with acute incarcerated hemorrhoids treated by surgery was performed. The patients were divided into PPH group (n=58) and MMH group (n=45) according to the different operation program who underwent. Operative time, pain score of VAS, time required for anodyne, postoperative complications, hospital stay, and hospital charges were compared. Results The symptoms were both relieved in two groups patients. Although the hospital charges of patients in MMH group were fewer, the patients in PPH group had advantages of shorter operative time, less postoperative pain, lower requirement for anodyne, fewer complications (edema of anal edge), and shorter hospital stay (Plt;0.01). Conclusion PPH is as safe and effective as MMH, and furthermore its short-term therapeutic effect is better than MMH.
目的 探讨低位直肠癌双吻合器保肛手术后吻合口漏的预防。 方法 回顾性分析2000年5月至2005年5月我院肛肠外科行双吻合器保肛手术的78例低位直肠癌患者的资料。结果 所有病例应用双吻合器进行直肠闭合并吻合成功,术后切缘病理检查均未见癌细胞浸润,无吻合口漏及手术死亡。随访73例(93.6%),随访时间9~65个月，平均35个月。盆腔复发2例(2.6%),腹腔广泛转移1例(1.3%),肝脏转移7例(9.0%),吻合口局部复发1例（1.3%,术后11个月再次行Miles术）。结论 双吻合技术为低位直肠癌患者提供更多的保肛机会,使用得当可有效预防吻合口漏的发生。
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。
目的 探讨直肠癌双吻合器保肛术后预防吻合口漏的措施。方法 回顾性分析2006年1月至2009年7月期间在我院行Dixon术的358例直肠癌患者的临床资料。结果 本组病例均一次吻合成功,术后出现吻合口漏30例（8.4%），多发生在术后5~10 d,均经非手术综合性措施治疗后漏口愈合,愈合时间14~60 d,中位时间37 d。结论 术前一般状况调整、术中严密操作、正确的引流管放置与灌洗引流、营养支持等综合性措施对低位直肠癌Dixon术后吻合口漏的防治效果较好。
Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.
ObjectiveTo evaluate the safety of shearing fracture ligation combining procedure for prolapse and hemorrhoids （PPH） in treatment for mixed hemorrhoids via a multicenter clinical study. MethodsTwo hundred and fortysix patients with mixed hemorroids were included from four a level of firstclass hospitals, which were averagely divided into shearing fracture ligation combining PPH group, PPH group, and shearing fracture ligation group according to the order of admission. The occurrence status of rectovaginal fistula, urethrorectal fistula, postoperative bleeding, acute urinary retention, anorectal stenosis, and anal incontinence were observed. And the anal function was evaluated by the anorectal pressure measurement. ResultsNo rectovaginal fistula or urethrorectal fistula happened among three groups. No anorectal stenosis happened in the shearing fracture ligation combining PPH group or the PPH group. The score of anorectal stenosis and anal incontinence in these two groups were lower than those in the shearing fracture ligation group (Plt;0.05). The rate of postoperative bleeding in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group (Plt;0.05). There were acute urinary retentions happened among three groups, but without significant differences among them (Pgt;0.05). The anal canal resting pressure after operation was lower than that before operation among three groups (Plt;0.01), which in the shearing fracture ligation combining PPH group was lower than that in the shearing fracture ligation group after operation (Plt;0.05). There were no significant differences of the rectum feeling capacity or maximum rectum capacity between the shearing fracture ligation combining PPH group and PPH group before and after operation (Pgt;0.05), but compared with the level before operation in the shearing fracture ligation group, the rectum feeling capacity obviously decreased after operation (Plt;0.05), the maximum rectum capacity obviously increased (Plt;0.05). There were no significant differences of the maxinum anal canal systolic blood pressure between before and after operation in three groups and among three groups (Pgt;0.05). ConclusionsThe operation of shearing fracture ligation combined with PPH can protect the tissue of rectal cushion, remain the normal anatomy structure of anal canal. It has better clinical effect and is much safer than other methods.