目的评价双吻合器在中、低位直肠癌保肛手术应用中的安全性和实用性。方法分析 38 例应用双吻合器行结、直肠吻合治疗中、低位直肠癌的经验。结果本组病例在使用双吻合器中闭合和吻合过程顺利、简捷，术后无1 例发生吻合口漏; 发生吻合口狭窄1例,发生率为2.6%, 经肛门指法扩肛后即痊愈; 局部复发2例,复发率为5.3%。结论双吻合器吻合法可作为中、低位直肠癌保肛手术的一种安全可靠的术式选择。
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.
目的 探讨肛管拖出式双吻合器在超低位直肠癌保肛手术中的应用价值。方法 回顾性总结我院23例超低位直肠癌保肛手术的经验。结果 本组病例利用肛管拖出和双吻合器技术行超低位保肛术均获成功，术后发生吻合口漏1例（4.3%），切口感染2例（8.7%），术后局部复发2例（8.7%），无手术死亡。结论 肛管拖出式双吻合器技术行超低位保肛术是安全可靠的，它可以大大提高超低位直肠癌保肛手术的成功率。
目的：探讨食道癌贲门癌术后两种重建方法的优劣。方法：实验组食管癌贲门癌切除术后采用圆形吻合器行食管胃器械吻合，吻合口4号丝线间断加强并另行吻合口大网膜缠绕并吻合合口减张。对照组行食管胃粘膜及粘膜下分层吻合加胃浆肌层与食管肌层缝合包埋吻合口并减张重建。比较两组手术时间，术后肺部感染和肺不张、吻合口瘘和狭窄及胃食管反流发生率。结果：实验组吻合口瘘发生率为0.6%（2/316），吻合口狭窄发生率为5.7%（18/316），对照组吻合口瘘发生率为1.6%（3/186），吻合口狭窄发生率为4.3%（8/186），均有显著性差异（P＜0.05）。吻合口近端胃食管反流液随机抽样检查pH值，差异无统计学意义（P＞0.05）。行机械吻合手术时间明显缩短，有统计学意义（P＜0.05）。实验组肺部感染发生率0.3%（1/316），无肺不张，对照组肺部感染发生率1.6%（3/186），肺不张0.5%（1/186），其差异有统计学意义（P＜0.05）。结论：食管癌贲门癌切除术中行机械吻合重建方便快捷，可减少并发症，适于临床临床推广。
目的 探讨吻合器痔上黏膜环切术(ＰＰＨ)对巨大型Ⅲ、Ⅳ度环状痔的临床应用价值。方法 采用美国强生公司生产的痔疮吻合器对38例巨大型Ⅲ、Ⅳ度环状痔患者进行手术,并分析其临床资料。结果 患者平均手术时间19 min,术后平均住院2.8 d，术后10例肛门疼痛较剧者使用了镇痛剂（其中6例加切了外痔）,13例有轻度疼痛，15例无疼痛。术后9例1～6 d有便血,其中1例为大出血，出血量约1 000 ml，均经保守治疗后好转。随访1～19个月，患者无大便失禁、肛周感染、脓肿及肛门狭窄发生。结论 ＰＰＨ治疗巨大型Ⅲ、Ⅳ度环状痔具有手术时间短、住院时间少、痛苦小、恢复快、疗效显著、并发症少的优势。
目的 对痔切除吻合器痔上黏膜环切术（PPH）与传统手术在治疗混合痔环状脱垂或内痔环状脱垂的疗效进行比较。方法 回顾性分析2002年1月至2004年9月西苑医院收治的832例经内镜确诊为内痔及混合痔患者的临床资料。结果 PPH组： 混合痔247例，治愈228例（92.3%），显效19例（7.7%）; 内痔168例均治愈（100%）； 术后发生大出血2例（0.5%），住院时间3.1~6.3 d，无一例创面感染。传统手术组： 混合痔229例中治愈215例（93.9%），显效14例（6.1%）; 内痔188例中治愈175例（93.1%），显效13例（6.9%）； 术后发生出血3例，肛管狭窄12例，并发症发生率为3.6%，住院时间26.2~27.1 d。结论 对痔的环形脱垂，采用PPH手术并与外痔切除或外剥内扎方法相结合，具有手术操作简单、安全、术后疼痛轻、恢复快等特点，优于传统的外剥内扎手术。
目的：总结吻合器痔上黏膜环切术（PPH）治疗痔病的经验。探讨该术式的有关问题，以便提高疗效。方法：回顾性分析了2001～2006年8月收治痔病541例，其中PPH术42例的临床资料。本组均为Ⅲ度或Ⅳ度痔。局部合并症共22例次：血栓外痔愈合后遗留皮赘14例，肛裂2例。有关全身合并症：前列腺增生7例，慢性泌尿系统感染1例。结果:42例中，35例术后2～5天出院，6例自愿留院到7天，1例慢性尿路感染者术后2～7天多次便血，再次手术后28日痊愈出院。随访13～24个月：32例恢复满意，10例有肛门包块感及包块排粪时轻度脱出，其中3例经进一步处理缓解，另7例观察治疗。结论:(1)PPH手术简单易行，疼痛轻，住院时间短，效果好。(2)为了提高效果术中应注意：①禁忌症为单个痔块脱出和肛管皮肤不平滑并纤维化的Ⅳ度病变者外。我们还发现慢性泌尿系统感染未彻底治愈者也应视为相对禁忌。明显前列腺增生者也应慎重。②术中按经典PPH手术的要求进行操作，扩肛器插入前后，不宜扩肛和下牵痔块。③个别巨大痔块及皮赘性痔块（tag）宜先行切除，再行本术。④重度脱出者，黏膜切除应宽大，必要时切除部分肛垫。
Objective To compare the clinical effect of tissue selecting therapy stapler (TST) and procedure for prolapse and hemorrhoids (PPH) in treatment of hemorrhoid in Ⅲ-Ⅳ degree. Methods Clinical data of 80 cases of hemorrhoid in Ⅲ-Ⅳ degree who treated in The First Affiliated Hospital of Harbin Medical University from May 2015 to July 2015 were retrospectively collected. All the 80 cases were divided into TST group (n=40) and PPH group (n=40) according to the surgical types. The comparison of the clinical effect of 2 groups was performed. Results The operative time, hospital stay, intraoperative blood loss, anal fall bilge feeling score, postoperative pain score at 3 time points, and the incidence of anal secretions of TST group were lower or shorter than those corresponding indexes of PPH group (P<0.05). But there was no significant difference in cure rate, the incidence of urinary retention, the incidence of anal stenosis, the incidence of intractable pain, and satisfaction situation between the 2 groups (P>0.05). All of the cases were followed up for 3 months, during the follow-up period, no one suffered from rectal vaginal fistula, fecal incontinence, and recurrence. Conclusion TST and PPH both have satisfactory effect in treatment of hemorrhoid in Ⅲ-Ⅳ degree, but TST has advan- tages of less blood loss, shorter operative time, rapid postoperative recovery, and less pain.
ObjectiveTo systematically review the efficacy and safety of nickel-titanium shape memory alloy compression anastomosis clip (Ni-Ti CAC) for gastrointestinal anastomosis. MethodsThe Cochrane Library, PubMed, Web of Knowledge and CBM databases were searched for the randomized controlled trials (RCTs) that investigated the efficacy and safety of Ni-Ti CAC versus surgical stapler for gastrointestinal anastomosis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2. ResultsEight RCTs involving 457 patients were included in the meta-analysis. The results of meta-analysis showed that, compared with the surgical stapler group, the Ni-Ti CAC group was superior in operation time (MD=-8.30, 95%CI-15.58 to-1.02, P=0.03), food intake (MD=-0.37, 95%CI-0.70 to-0.03, P=0.03), bowel movement (MD=-1.13, 95%CI-1.67 to-0.59, P < 0.000 1), passing gas time (MD=-0.30, 95%CI-0.55 to-0.06, P=0.01), and length of hospital stay (MD=-1.04, 95%CI-1.35 to-0.74, P < 0.000 01), with significant differences. No significant difference was found in anastomosis time (MD=-1.84, 95%CI-3.91 to 0.22, P=0.08). As for safety, no significant difference was found in anastomosis-related complications between both groups. ConclusionCurrent evidence shows that Ni-Ti CAC achieves better efficacy and safety in gastrointestinal anastomosis compared with surgical stapler.