直肠拖出双吻合治疗低位直肠癌的前瞻性研究

目的探讨直肠经肛门拖出式切除、双吻合技术治疗低位直肠癌的临床疗效。方法将1997年1月至2005年12月72例低位直肠癌患者分为经肛门拖出切除、双吻合组(A组,n=36)和低位前切、双吻合组(B组,n=36)。分析术后控制排便功能、并发症、复发和转移率以及1、3、5年生存率。结果随访截至2010年6月30日。两组患者均保肛成功,无手术死亡,术后病理切缘均未见癌细胞浸润。术后pTNM分期、控制排便功能,两组比较差异无统计学意义(P>0.05)。复发和转移率A组(11.1%)优于B组(30.6%)(P<0.05)。两组术后并发症发生率为5.6%vs.13.9%,死亡率为19.4%vs.22.2%,1、3、5年的生存率分别为91.7%、83.3%、80.6%vs.94.4%、80.6%、77.8%,A组优于B组,但无统计学意义(P>0.05)。结论经肛门拖出切除、双吻合技术治疗低位直肠癌保肛成功率高,简单,并发症少,复发率低。选择合适的患者施行该术式是保证疗效的关键。

Transanal pull-through combined with double stapling technique for low rectal carcinoma

Objective To study the clinical effect of transanal pull-through combined with double stapling technique for low rectal carcinoma.Methods From January 1997 to December 2005,72 patients of low rectal carcinoma had been enrolled in this prospective controlled study.With informed consent,they underwent transanal pull-through combined with double stapling technique（group A）,36 cases and low anterior resection combined with double stapling technique（group B）,36 cases.According to the criteria,rectal function,complication,recurrence,metastasis rates and survival were analysed.Results On the close day of June 2010,all patients were followed up.The anus of all patients were conserved with no death during operation.No infiltration of carcinoma cell were observed at the incision margin.The pTNM stages,the morbidity of complications,rectal function were not statistically significant difference（P0.05）.The recurrence and metastasis rates were 11.1% vs.30.6%,two groups were statistically significant difference（P0.05）.The mortality were 19.4% vs.22.2%,and the 1-,3-,5-survival rates in group A（91.7%,83.3%,80.6%）were superior to that in group B（94.4%,80.6%,77.8%）.But they were were not statistically significant difference（P0.05）.Conclusions Transanal pull-through combined with double stapling technique for low rectal carcinoma is simple and easy to perform for effective anus conservation with low postoperative morbidity and the recurrence rates.It is a useful option that selecting the candidates of low rectal carcinoma by Transanal pull-through combined with double stapling technique.