摘要
目的探讨超低位直肠癌经腹肛门内括约肌切除术保肛手术的疗效。方法选择我院2009年3月至2011年3月超低位直肠癌患者共22例,根据患者具体情况实施全身麻醉或者硬膜外麻醉,实施超低位直肠癌经腹肛门内括约肌切除术保肛手术。术后对所有患者进行随访。结果该组无手术死亡,术后吻合口发生出血1例,经缝合后血止;出现吻合口瘘1例,均采取保守治疗后痊愈。该组患者随访时间为(18±6)个月,术后6个月局部复发1例,术后10个月局部复发2例,其中1例拒绝再次手术,术后18个月因癌转移死亡,其余2例改行Miles手术而存活。术后6个月排便紧迫感发生率、术后排便次数和大便失禁发生率显著低于术后3个月和术后1个月(P<0.05),且术后Kirwan分级主要集中于1～3级,随着时间的增加其级别也随之降低。结论经腹肛门内括约肌切除术保肛手术治疗超低位直肠癌有较好的根治效果,患者术后早期肛门功能保留良好,临床效果显著,值得借鉴。
Objective To discuss the clinical effect of abdominal-anal intersphincteric resection with anal sphincter preservation for super-low rectal carcinoma. Methods 22 cases with super-low rectal carcinoma from Mar. 2009 to Mar. 2011 were performed abdominal-anal intersphincteric resection with anal sphincter preserva- tion under general anesthesia or epidural anesthesia according to patients＇conditions. All the patients were fol- lowed up after operation. Results No operation death. After operation, 1 case anastomotic hemorrhage oc- curred, then stopped by suture. 1 case of anastomotic leakage was cured by expectant treatment. The average fol- low-up time was （ 18 ＋ 6 ） months, 1 case had local recurrence in 6 months after operation, and 2 cases had local recurrence in 10 months. Among these 3 cases, 1 case refused to accept secondary operation and died of metasta- sis in 18 months,while the other 2 cases underwent Miles operation and was survival. The sense of urgency for defecation,defecation frequency, and incidence of fecal incontinence in 6 months after operation were signifi- cantly lower than that in 3 months and 1 month after operation, these differences was statistically significance（ P 〈 0.05 ）. Postoperative Kirwan grading mainly localized in 1-3 level, and decreased as time increased. Conclu- sion Abdominal-anal intersphinctefic resection has obvious radical cure effect in treatment of super-low rectal carcinoma. Anal function is good in early stage after operation. This operation is worthy of clinical promoting.
出处
《医学综述》
2012年第19期3309-3310,共2页
Medical Recapitulate
关键词
超低位直肠癌
经腹肛门内括约肌切除术
保肛术
Super-low rectal carcinoma
Abdominal-anal intersphincteric resection
Anal sphincter pres- ervation
