Miles手术治疗低位直肠癌临床效果分析

目的探讨低位直肠癌患者Miles手术后会阴部手术切口感染的临床效果。方法对2008年3月—2013年3月期间在绍兴市第五医院进行治疗的低位直肠癌患者356例进行回顾性研究。其中单纯Miles手术患者187例，术前化疗后手术患者169例。对2组患者的术后切口感染率、切VI部位病原菌分布情况以及术后并发症进行分析；对术后5年生存率、转移率及复发率进行分析。结果356例患者中共有69例发生了感染，感染率为19．4％；单纯Miles手术感染率为8．0％（15／187），手术联合术前化疗感染率为31．9％（54／169）；低位直肠癌患者术后病原菌分布以革兰阴性菌为主，占42株，占56％；革兰阳性菌共27株，占36％，其他病原菌6株，占8％；2组术后并发症比较无差异；单纯Miles手术5年生存率为42．2％（79／187）、转移率为43．3％（81／187）、复发率为12．8％（24／187）；手术联合化疗组5年生存率为60．4％（102／169）、转移率为21．3％（36／169）、复发率为11．2％（19／169）。单纯Miles手术感染率低于术前化疗组（P〈0．05）；单纯Miles手术5年生存率和转移率优于术前化疗组（P〈0．05），2组患者的5年复发率差异无统计学意义（P〉0．05）。结论术前化疗联合Miles手术治疗低位直肠癌，在术后5年生存率和转移率上优于单纯Miles手术，但缺点是手术切口感染率较高。

Clinical effects of miles operation on low colorectal cancer

Objective To investigate the incidence of infection of incisional wound after Miles operation in patients low colorectal cancer. Methods The clinical data of 356 cases of low colorectal cancer from March 2008-March 2013 in our hospital were reviewed retrospectively. 187 cases underwent Miles operation only,while other 169 cases received Miles op- eration and preoperative chemotherapy. The postoperative rate of wound infection, distribution of pathogens in wound infec- tion, postoperative complications were analyzed. 5-year survival, metastasis and recurrence rate were evaluated. Results Total 69 in 356 cases were with infection with a rate of 19.4% ;the infection rate was 4.8% （ 10/187 ） in the simply Miles surgery group ,34.9% （54/169） in the Miles surgery with preoperative chemotherapy, the difference was significant. The distributions of pathogens in wound infection were 42 strains of gram-negative bacteria,27 strains of gram-positive bacteri- a ,6 strains of other bacteria. There was no difference in the incidence of postoperative complieations. 5-year survival rate, metastasis rate and recurrence rate were 42.2% （79/187） ,43.3% （81/187） and 12.8% （24/187） in the Miles surgery group,and 60.4% （102/169） ,21.3% （36/169） and 11.2% （19/169） in the Miles operation with preoperative chemo- therapy group. The difference in 5-year survival rate and metastasis rate was statistically significant between two group （ P 〈 0.05）, but in the recurrence rate was not significant （ P 〉 0.05 ）. Conclusion Miles operation combined with pre- operative chemotherapy can improve the 5-year survival rate, decrease the metastasis rate, but the postoperative rate of wound infection was higher.