摘要
目的探讨保肛术式和Milse术式治疗直肠癌的临床疗效。方法回顾性分析1980年1月至2006年572例直肠癌手术,其中施行各种保肛术式403例和Milse术式169例。对患者术后并发症、复发率、转移率和五年生存率等进行比分析。结果随访时间为0.5～25年,中位随访时间为9.5年,随访率为76.2%(436/572)。术后总的局部复发率为6.7%(29/436),各种保留肛门术式为6.3%(20/317),其中套入式结肠直肠黏膜吻合保肛术为4.9%(9/182),Dixon手术为7.2%(4/55),改良Bacon术为11.1%(1/9),前切除吻合器吻合术为8.4%(6/71),Miles手术为7.6%(9/119),差异无统计学意义(x^2=1.3942,P>0.05),显示出术后局部复发率略有下降可能与近年来重视直肠全系膜切除有关。术后总的远处转移率为15.8%(69/436)。各种保留肛门术式为15.7%(50/317),Miles手术为16.2%(19/119),差异无统计学意义(x^2=0.6672,P>0.05)。术后总体5年生存率为67.6%(295/436),其中Miles手术为68.3%(80/119),保留肛门手术为67.8%(215/317)。其中套入式结肠直肠黏膜吻合保肛术为72.5%(132/182)。比较术后五年生存率套入式吻合保肛术略有提高,但差异无统计学意义(x^2=0.6672,P>0.05)。表明了与近10年来TME手术开展,以及综合治疗手段得到了加强有关。结论直肠癌保肛术后局部复发率和五年生存率与Miles手术基本相同,但患者生活质量得到明显提高。直肠癌术式确定应根据病变部位、生物学特性,临床分期、进行个体化选择。
Objective To study clinical therapeutic effects Jf sphincter-pre-serving operation and Milse operation for rectal cancer.Methods A retrospective a-nalysis was made on 572 patients with rectal cancer who had undergone operations from January 1980 to December 2006.Anus-preserving operation was performd in 403 pa-tients,and Miles operation in 169.Results The follow up rate was 76.2% (436/572).The follow up time ranged from 0.5 to 21 years(median 49.5 years).The local recurrence for anus-preserving operatian was 6.7%(27/436),for casing an-astomosis of colo and rectal umcosa,4.9%(9/182),for Dixson,7.2%( 4/55),for stapler operation,8.4%(6/71),and for nodified Bacon,11.1%(1/9).The local re-currence for Miles operation was 7.6%(9/119)(x2=1.3942,P>0.05).The de-creased local recurrence in recent years may be related to the TME procedure.The O-anus-erving operation,67.6%(297/413),and for casing anastomosis,72.5%(132/ 182) Conclusions The life quality of patients can be improved significantly after sphincter-preserving operation and their 5-year survival rate is similar to that of pa-tients after Miles operation.The operation for rectal cancer should be performed indi-vidually according to the location,the bionomics,and the clinical stage.
出处
《中华普外科手术学杂志（电子版）》
2007年第1期35-37,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
关键词
直肠肿瘤
直肠结肠切除术
重建性
Rectal neoplasm
Rectal cancer excision
Anastomosis of colon and rectal mucosa
Milse operation
