切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 361 -366. doi: 10.3877/cma.j.issn.2095-3224.2022.05.002

青年专家论坛

拖出式二期结-肛吻合在低位直肠癌中的应用及思考
胡军红1,(), 白杨1   
  1. 1. 450052 郑州大学第一附属医院结直肠肛门外科
  • 收稿日期:2022-04-18 出版日期:2022-10-25
  • 通信作者: 胡军红
  • 基金资助:
    河南省医学科技攻关计划(省部共建重点)项目(SBGJ202102121)

The clinical application and consideration of delay colo-anal anastomosis by pull-through in low rectal cancer

Junhong Hu1,(), Yang Bai1   

  1. 1. Department of Colorectal Anal Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2022-04-18 Published:2022-10-25
  • Corresponding author: Junhong Hu
引用本文:

胡军红, 白杨. 拖出式二期结-肛吻合在低位直肠癌中的应用及思考[J/OL]. 中华结直肠疾病电子杂志, 2022, 11(05): 361-366.

Junhong Hu, Yang Bai. The clinical application and consideration of delay colo-anal anastomosis by pull-through in low rectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(05): 361-366.

随着微创平台的创新、微创技术的提高及多学科团队协作(MDT)应用,低位直肠癌保肛患者越来越多,与手术相关的并发症(吻合口漏、盆腔慢性感染、直肠阴道瘘等)也相应增多。拖出式二期结-肛吻合近些年来临床应用逐渐增多,由于将近断端肠管拖出肛门外二期进行吻合,与直接一期结-肛吻合比较,并不增加围手术期并发症的发生率,避免了预防性造口,降低了住院费用,提升了生活质量,远期的肛门功能和肿瘤学效果满意,尽管这种手术方式有一定的优点,但也存在一定的争议和质疑,本文结合文献及笔者团队近三年开展的临床病例资料,就此种手术的命名方式、适应证选择、相关并发症、肛门功能及肿瘤学效果进行客观评价,仅供临床读者参考。

With the innovation of minimally invasive platform, the improvement of minimally invasive technology and the application of MDT, the numbers of postoperative anal-preserving surgery patients with low rectal cancer is increasing, and the complications related to surgery (anastomotic leaking, chronic pelvic infections, recto-vaginal fistulae) are also increasing accordingly. The clinical application of delay colo-anal anastomosis by pull-through has been increasing in recent years. Compared with immediate colo-anal anastomosis, delay colo-anal anastomosis does not increase the incidence of perioperative complications,avoids a prophylactic stoma,reduces hospitalization costs,improves quality of life, and has satisfactory long-term anal function and oncology results . Although this method has certain advantages, it also has certain controversies and doubts. Based on the literature and clinical cases carried out by the author's team in the past 3 years, this paper objectively evaluated the nomenclature, indication selection, related complications, anal functional and oncological results for the reference of clinical readers.

图1 术后30天腹壁情况
图2 外置肠管形态
图3 外置肠管部分缺血
图4 外置肠管完全坏死
图5 15天愈合情况
图6 8天愈合情况
图7 局部缝合情况
图8 术毕肛门形态
图9 15天后肛门形态
图10 21天后肛门形态
[1]
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020[J]. CA Cancer J Clin, 2020, 70(1): 7-30.
[2]
Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery[J]. Int J Colorectal Dis, 2017, 32(4): 549-556.
[3]
Hammond J, Lim S, Wan Y, et al. The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes[J]. J Gastrointest Surg, 2014, 18(6): 1176-1185.
[4]
Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis[J]. Ann Surg, 2011, 253(5): 890-899.
[5]
Munakata S, Ito S, Sugimoto K, et al. Defunctioning loop ileostomy with restorative proctocolectomy for rectal cancer: friend or foe? [J]. J Anus Rectum Colon, 2018, 1(4): 136-140.
[6]
Murken DR, Bleier JIS. Ostomy-related complications[J]. Clin Colon Rectal Surg, 2019, 32(3): 176-182.
[7]
Nugent KP, Daniels P, Stewart B, et al. Quality of life in stoma patients[J]. Dis Colon Rectum, 1999, 42(12): 1569-1574.
[8]
Ayaz-Alkaya S. Overview of psychosocial problems in individuals with stoma: a review of literature[J]. Int Wound J, 2019, 16(1): 243-249.
[9]
Turnbull RBJr, Cuthbertson A. Abdominorectal pull-through resection for cancer and for Hirschsprung's disease: delayed posterior colorectal anastomosis[J]. Cleve Clin Q, 1961, 28(4): 109-115.
[10]
Cutait DE, Figliolini FJ. A new method of colorectal anastomosis in abdominoperineal resection[J]. Dis Colon Rectum, 1961, 4(5): 335-342.
[11]
Vogel JD, Johnson EK, Morris AM, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula[J]. Dis Colon Rectum, 2016, 59(12): 1117-1133.
[12]
Portale G, Popesc GO, Parotto M, et al. Delayed colo-anal anastomosis for rectal cancer: pelvic morbidity, functional results and oncological outcomes: a systematic review[J]. World J Surg, 2019, 43(5):1360-1369.
[13]
Hallet J, Milot H, Drolet S, et al. The clinical results of the Turnbull-Cutait delayed coloanal anastomosis: a systematic review[J]. Tech Coloproctol, 2014, 18(6): 579-590.
[14]
Portale G, Popesc GO, Parotto M, et al. Delayed colo-anal anastomosis for rectal cancer: pelvic morbidity, functional results and oncological outcomes: a systematic review[J]. World J Surg, 2019, 43(5): 1360-1369.
[15]
Sage PY, Trilling B, Waroquet PA, et al. Laparoscopic delayed coloanal anastomosis without diverting ileostomy for low rectal cancer surgery: 85 consecutive patients from a single institution[J]. Tech Coloproctol, 2018, 22(7): 511-518.
[16]
Guner OS, Tumay LV. Turnbull-Cutait technique without ileostomy after total mesorectal excision is associated with acceptably low early post-operative morbidity[J]. ANZ J Surg, 2021, 91(1-2): 132-138.
[17]
Baulieux J, Olagne E, Ducerf C, et al. Oncologic and functional results of resections with direct delayed coloanal anastomosis in previously irradiated cancers of the lower rectum[J]. Chirurgie, 1999, 124(3): 240-251.
[18]
Hautefeuille P, Valleur P, Perniceni T, et al. Functional and oncologic results after coloanal anastomosis for low rectal carcinoma[J]. Ann Surg, 1988, 207(1): 61-64.
[19]
Lazorthes F, Chiotasso P, Gamagami RA, et al. Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis[J]. Br J Surg, 1997, 84(10): 1449-1451.
[20]
Berger A, Tiret E, Parc R, et al. Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum[J]. World J Surg, 1992, 16(3): 470-477.
[21]
Rullier E, Laurent C, Bretagnol F, et al. Sphincter-saving resection for all rectal carcinomas:the end of the 2-cm distal rule[J]. Ann Surg, 2005, 241(3): 465-469.
[22]
Cutait DE, Cutait R, Ioshimoto M, et al. Abdominoperineal endoanal pull-through resection. A comparative study between immediate and delayed colorectal anastomosis[J]. Dis Colon Rectum, 1985, 28(5): 294-299.
[23]
Biondo S, Trenti L, Espin E, et al. Two-stage turnbull-cutait pull-through coloanal anastomosis for low rectal cancer: a randomized clinical trial[J]. JAMA Surg, 2020, 155(8): e201625.
[24]
Portale G, Popesc GO, Parotto M, et al. Delayed colo-anal anastomosis for rectal cancer: pelvic morbidity, functional results and oncological outcomes: a systematic review[J]. World J Surg, 2019, 43(5): 1360-1369.
[25]
Boullenois H, Lefevre JH, Creavin B, et al. Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis[J]. Colorectal Dis, 2020, 22(8): 885-893.
[1] 王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[3] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[6] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7] 郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[8] 池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[9] 李明, 屠松, 闫鹏, 钱军, 高鹏程, 许文山, 杨发英, 胡振涛, 单永玮. 应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 603-606.
[10] 李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[11] 赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[12] 吴胜伟, 王志伟, 陈贵进, 刘序, 吴晓翔. 系膜肥厚低位直肠癌患者改良NOSES Ⅰ式手术的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 615-618.
[13] 庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[14] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[15] 梁轩豪, 李小荣, 李亮, 林昌伟. 肠梗阻支架置入术联合新辅助化疗治疗结直肠癌急性肠梗阻的疗效及其预后的Meta 分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 472-482.
阅读次数
全文


摘要