从术后局部复发形式探讨直肠癌保肛手术的适应证

分析我科收治的１２９例局部复发直肠癌复发形式的特征，指出第一次行Ｄｉｘｏｎ手术者以吻合口及其周围组织的复发最多，第一次行拉出术者以拉出肠管及其周围组织复发最多。并结合直肠癌壁内逆向浸润及淋巴转移规律的研究结果。分析了复发的原因，进而提出保肛手术的原则及适应证：保肛手术必须在充分清除淋巴结，清除足够的侧方组织及切除足够的远端正常肠管的基础上根据肿瘤的部位选择不同的保肛手术，即肿瘤下缘距肛缘８ｃｍ者行Ｄｉｘｏｎ手术，７ｃｍ者行Ｔｕｒｂｕｌｌ－Ｃｕｔａｉｔ手术，６ｃｍ者行Ｂｌａｃｋ或Ｂａｂｃｏｃｋ手术，５ｃｍ者行Ｂａｃｏｎ或Ｗａｕｇｈ手术，且指出保肛手术宜选择病期较早者进行。

On Indications of Anus Preservation in Patients with Rectum Cancer Basing on the Patterns of Local Recurrence

Based on the patterns of local recurrence in 129 postoperative rectal cancer patients.It was found that after Dixon's operation,the recurrence mainly occurred at the anastomotic stoma and its surroundings.Dictated by the tendency of retrograde infiltration and lymphatic migration of the rectal carcinoma,the rectum resection should be performed with clearance of sufficient lymphatic tissue and ample distal rectum along with enough peripheral tissue.The type of the anus preservation operation varies with location of the tumor.In tumors with its lower edge 8cm off the linea alba.Dixon operation should be optimal,while Turbull-Cutait operation should be of choice for lesions with its lower edge 7cm off the linea alba.Likewise,Blaxk operation or Babcock operation 6cm.Bacon operation or Waugh operation should-de reserved for those 5cm away form the anus margin.