摘要
目的探讨经腹肛门切除肛门内括约肌的直肠癌根治保肛术治疗超低位直肠癌的临床疗效。方法对52例癌灶下缘距肛缘4—5cm的超低位直肠癌经腹肛门切除肛门内括约肌加结肠套叠重建内括约肌保肛术进行临床分析。52例中男29例，女23例。年龄28～76岁，平均为56．3岁。癌灶下缘距肛缘4cm18例，癌灶下缘距肛VI5em34例。病理诊断直肠腺癌52例，其中高分化者21例，中分化者29例，低分化者2例，腺瘤癌变6例。Dukes分期：A期28例，B期24例。结果52例术后随访率为88％（46／52），术后随访时间2个月至12年，中位随访时间为5．9年。术后发生吻合口瘘2例（3．8％），吻合口狭窄3例（5．7％），术后6～12个月时肛门排便控制功能基本恢复到正常。术后局部复发3例，术后5年生存率为24／33例（73％）。结论切除肛门内括约肌的直肠癌根治保肛术能保留良好的肛门排便控制功能，不增加局部复发率，是一种安全有效的超低位直肠癌保肛术式。
Objective -To study ciinical therapeutic effects of anus-preserving operation with resecting anal intersphincter to treat ultra-low rectal cancer through abdominal cavity. Methods We retrospectively analyzed 52 cases of ultra-low rectal cancer, with the inferior border of the cancers within ：2 cm to anocutaneous line or 5 cm to the edge of anus treated by anus-preserving operation with resecting archos internal sphincter muscles through abdominal cavity and anus. There were 29 males, and 23 females, with age 28 to 76 years old, averaging 56. 3 years old. The inferior border of the cancer were within 4 cm to the edge of anus in 18 cases, including 6 cases of adenoma cancerization, and 5 cm to the anus in 34 cases. Pathologic diagnosis was well-differentiated adenocarcinoma in 21 cases, moderately differentiated in 29 cases, low differentiated in 2 cases, there were 6 cases with adenoma cancerization. 28 cases were Dukes A stage, and 24 B stage. Results The follow-up rate was 88.4% （46/52）, and the median time was 5.9 years. 2 case developed stoma leak （3.8%） , and 3 developed stoma stenosis（5.7% ） after operation. The anus could roughly control defecation in 6 - 12 mouths after operation. The local recurrence rate was 5. 7%, and the 5-year-survival rate was 72.7%. Conclusion By anus-preserving operation with resecting archos internal sphincter muscles, defecation controlling was well reserved by anus, and the 5-year-survival rate was not cut down. This operation is one of the safe and effective operations of anus-preserving procedure.
出处
《中华普通外科杂志》
CSCD
北大核心
2009年第8期628-630,共3页
Chinese Journal of General Surgery
