이중문합술을 이용한 저위전방절제술에서 직장절단세척의 효용성
Efficacy of Stump Irrigation in Removing Tumor Cells During Low Anterior Resection Using the Double Stapling Technique
박상준, 김희철, 유윤식, 유장학, 유창식, 김진천,
소속 상세정보
박상준 ( Park Sang-Jun )
울산대학교 의과대학 외과학교실
김희철 ( Kim Hee-Cheol )
울산대학교 의과대학 외과학교실
유윤식 ( Yoo Yuen-Sik )
울산대학교 의과대학 외과학교실
유장학 ( Yoo Jang-Hak )
울산대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik )
울산대학교 의과대학 외과학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 외과학교실
KMID : 0356720040200010052
Abstract
Background: In low rectal cancer, creating a permanent stoma can be avoided by applying a low anterior resection using the double stapling technique. However, the problem of local recurrence is still a major pattern of tumor recurrence in rectal cancer. We aimed to verify the clinicopathologic variables related to exfoliation of tumor cells and searched for an efficient method to remove the tumor cells from the rectal stump during a low anterior resection.
Methods: Forty-four patients who underwent a low anterior resection using the double stapling technique were enrolled prospectively. For patient, we irrigated each rectal stump twice with 500 cc of normal saline through the anus. Two specimens from each irrigation were obtained and examined for any malignant tumor cells. Cases in which no tumor cells were found from the two specimens were defined as Group I, cases in which tumor cells were found in only the first specimen were defined as Group II, and cases in which tumor cells were found in both the first and the second specimens were defined as Group III. Clinicopathologic variables were analyzed with regard to the presence of exfoliated tumor cells in irrigated saline.
Results: There were sixteen (36%), fourteen (32%), and fourteen cases (32%) in Groups I, II, and III, respectively, according to the examination results. Age classification (P=0.05) and metastatic lymph nodes (P=0.013) were associated with the presence of tumor cells in irrigated saline (I vs. II, II).
Conclusions: Stump irrigation during a low anterior resection using the double stapling technique is recommended as an easy and simple method to remove exfoliated tumor cells from anastomosis sites, although further study is necessary to elucidate the association between exfoliated tumor cells and local recurrence. J Korean Soc Coloproctol 2004;20:52-56
키워드
외과적스테플링;세척;직장종양/수술;박탈된 종양세포;국소성종양재발
Surgical stapling;Irrigation;Rectal neoplasms/ surgery;Exfoliated tumor cells;Neoplasm recurrence;Local
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