低位直肠癌套入式结肠直肠黏膜吻合保肛术102例

目的 探讨套入式结肠直肠黏膜吻合术治疗低位直肠癌保留肛门括约肌功能的安全性和可行性。方法 对102例中下段直肠癌行经腹肛门切除套入式结肠直肠黏膜吻合术治疗的病例进行回顾性总结。结果 102例患者术后未发生吻合口瘘和吻合口狭窄。术后早期排便次数较多,6～12次／d,口服止泻药物,可达到控制排便次数,术后12～18周时肛门排便功能基本恢复到正常。患者随访率89．2％(91／102),平均随访4．8年。局部复发率为5．4％(5／91),肝转移率为13．1％(12／91)。术后3年生存率为86．9％(60／68)。术后5年生存率为70．7％(29／41)。结论 套入式结肠直肠黏膜吻合术既可避免结肠造口,又可有效防止吻合口瘘,是一种安全有效的直肠癌保肛术式。

Clinical study of 102 cases of abdominal-anus resection with telescopic anastomosis of colon rectal mucosa for lower segment of rectal cancer

Objective To investigate the reliability and feasibility of abdominal-anus resection with preservation of anal sphincter by telescopic anastomisis of colon rectal mucosa for middle-lower segment of rectal cancer. Methods A retrospective analysis was made for abdominal-anus resection with telescopic anastomosis of colon rectal mucosa in 102 cases of middle-lower segment of rectal cancer. Results No anastomotic fistula and anastomotic stenosis occurred in the 102 cases. The increased defecation was found during early stage of postoperation, about 6-12 times per day. But this was easily controlled by antidiarrheal drugs. Twelve to 18 weeks later, defecation returned to normal. Follow-up was performed in 91 patients, and the fowllow-up rate was 89.2%. Mean follow-up period was 4.7 years. Local recurrence rate of the carcinoma was 5.4%(5/91), and hepatic metastasis rate was 13.1%(12/91). Three-year survival rate of postoperation was 86.9%(60/80), and five-year survival rate was 70.7%(29/41). Conclusions With telescopic anastomosis of colon rectal mucosa, colon stoma can be avoided, and anastomotic fistula can be prevented. The operation is safety and effective in preservation of anal sphincter for rectal cancer therapy.