拖出式Welch法直肠癌超低位切除的临床研究

目的：探讨中下段直肠癌保留肛门括约肌功能手术的安全性及效果。方法：对24例中下段直肠癌患者实施拖出式Welch法超低位切除术，即肿瘤切除后使直肠远端外翻，近端结肠经外翻的直肠拖出，于肛门外行结肠-直肠-期吻合，待吻合确实后还纳入肛门内。结果：肿瘤局部复发3例（12．5％）Dukes，B期1例（4．2％），C期2例（8．4％）。术后6个月排便次数、控便机能正常及良好者21例（87．5％），较差者3例（12．5％）。5年生存率62．5％（15／24）。结论：保留肛门括约肌的拖出式吻合术，在确保癌根治的情况下，选择合适的病例，可获得较高的生存率及生活质量。

Outcome analysis of Pull-through Welch procedure for the resection of ultralow rectal carcinoma

Objective:To evaluate the safty and efficacy of pull through procedure for the resection of middle or low rectal cancer. Methods:Pull through ultralow resection was performed on 24 rectal cancer patients. The technique was in brief to make colorectal anastomosis through an everted rectal stump outside, and finally pull the proximal colon back into the pelvic cavity. Results:The anus 5 year follow up found the local recurrence rate was 12.5%(3 cases), including 1 (4.2%) of Dukes B and 2 (8.4%) of Dukes C. The 5 year survival rate is 62.5%(15/24). Normal or good fecal continence during six months postoperation was achieved in 21 cases (87.5%),fair in 3 cases(12.5%). Conclusion:Anal sphincter preserving pull through Welch procedure provides an effective treatment for middle and low rectal cancer with a satisfactory long term survival rate and quality of life.