目的 探討應用國產吻合器行直腸癌前切除雙吻合器吻合術的可行性。方法 對38例直腸癌患者行前切除時，應用國產直線及管狀吻合器行雙吻合器吻合。結果 術后發生吻合口漏2例(5.3%)，1例可能與術后早期腹腔化療有關，另1例形成直腸陰道瘺。全組無吻合口狹窄。結論 國產吻合器在使用上雖不如進口一次性吻合器方便，但如果操作得當，技術熟練，仍可獲類似效果，其費用僅為進口吻合器的1/30。新的改進型中國產品應用更方便，更易使此技術推廣。
目的評價雙吻合器在中、低位直腸癌保肛手術應用中的安全性和實用性。方法分析 38 例應用雙吻合器行結、直腸吻合治療中、低位直腸癌的經驗。結果本組病例在使用雙吻合器中閉合和吻合過程順利、簡捷，術后無1 例發生吻合口漏; 發生吻合口狹窄1例,發生率為2.6%, 經肛門指法擴肛后即痊愈; 局部復發2例,復發率為5.3%。結論雙吻合器吻合法可作為中、低位直腸癌保肛手術的一種安全可靠的術式選擇。
Objective To compare the effects of double stapling technique （DST） and single stapling technique （SST） in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer. Methods The clinical data of 351 patients with rectal caner， who were treated with low or ultralow anterior resection and colon-anal canal anastomosis in West China Hospital from Jan. 2009 to Dec. 2010， were collected and analyzed retrospectively. Operative and postoperative indexes of patients treated with DST （n=302） and SST （n=49） were compared. Results Compared with DST group， the distance from the dentate line to the edge of tumor， the length of the distal surgical margin 〔（1.83±0.59） cm vs. （2.07±0.56） cm〕， and hospitalization cost 〔（24 350.48±7 812.73） yuan vs.（29 455.32±7 869.33） yuan〕 of SST group were shorter or lower （P＜0.05）， but operative time was longer 〔（112.86±39.29） min vs. （100.10±36.75） min， P＜0.05〕. There were no significant differences on blood loss， duration of firstambulation， duration of first passing flatus， duration of first bowel movement， duration of pulling out nasogastric tube， duration of pulling out urinary catheter， duration of pulling out drain， postoperative hospital stay， total length of hospital stay， and the incidence of complication between the 2 groups （P＞0.05）. All patients were in functional recovery of anal control after operation. All patients were followed-up for 6-24 months （average 16 months）. During the followed-up， only 1 case suffered local tumor recurrence （SST group）， 3 cases suffered distant metastases （all in DST group）， and 15 cases （4.27％） died， of which 13 cases （4.30％） in DST group and 2 cases （4.08％） in SST group. Conclusions As in the low or ultralow anterior rectal resection and colon-anal canal anastomosis for patients with rectal cancer， SST results in shorter distal surgical margin than DST， so SST is suitable for the patients with shorter distance from the dentate line to the edge of tumor. What’s more， it saves the hospitalization cost effectively.
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 探討圓形吻合器在高齡賁門胃底癌經腹切除術中的應用。方法 回顧性分析1999年1月至2009年5月期間在我院接受圓形吻合器經腹切除術的238例70歲以上高齡賁門胃底癌患者的臨床資料，并對圍手術期結果進行分析。 結果 全組手術時間3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。術中并發大出血1例，給予積極止血，無術中死亡。所有病例機械吻合術后未出現吻合口漏。術后60例患者（25%）出現不同程度的并發癥，其中吻合口出血2例, 左側胸腔積液13例，肺部感染15例, 心衰3例, 肺不張2例, 心律失常10例，右側胸腔積液15例。無圍手術期死亡。術后隨訪3年，出現返流性食管炎45例，吻合口狹窄30例，無吻合口腫瘤復發，3年生存率為64%(152/238)。結論 應用圓形吻合器在高齡胃底賁門癌患者經腹切除術是安全、有效的。
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 探討吻合器痔上黏膜環切術（PPH）的操作技巧、臨床療效及并發癥。方法 根據患者具體情況，采用PPH術個性化治療重度痔病患者128例，分析其手術操作技巧與臨床療效及術中、術后并發癥的關系。結果 手術持續時間平均為30min，切除組織寬度平均為3.5cm。術中出血58例，其中滲血42例，搏動性出血16例。術后出血5例，吻合口感染1例；無大便失禁、吻合口狹窄。術后6個月隨訪，106例外脫痔塊完全回縮，7例回縮不全，15例失訪。結論 PPH術已被初步證明是一種微創、安全、有效的手術，但尚需進一步的經驗積累及大規模臨床試驗加以驗證。