内括约肌切除术治疗低位直肠癌的可行性和疗效

目的：探讨内括约肌切除术（ISR）在直肠癌保肛手术中的可行性及疗效。方法：回顾分析2000年1月—2005年8月42例低位直肠癌患者的手术资料,全部患者均行ISR。术后应用病理大切片技术检测环周切缘有无癌浸及其程度,统计术后并发症发生率,评估排便功能。结果：环周切缘有癌浸润2例。术后并发症：大便失禁30例,但患者均于1周内恢复;吻合口瘘2例;吻合口狭窄2例;术后肿瘤复发2例,均再次手术切除;肝转移癌并死亡1例。38例患者术后排便功能指标、直肠测压结果均于术后9个月时趋于正常,其余3例患者于术后18个月时趋于正常,1例于术后15个月死亡。结论：ISR能为低位直肠癌患者保留肛门,在保证手术根治性效果的同时,不增加术后并发症,并获得较满意的排便功能。

Parallelism Efficacy in Low Rectal Cancer Surgery with Inter-Sphincteric Resection

Objective：To evaluate the feasibility and clinical efficacy of inter-sphincteric resection in anus-preserving surgery of rectal cancer.Methods： The clinical datas of 42 patients with low rectal cancer from January 2000 to August 2005 were reviewed.All of the patients operatied by inter-sphincteric resection then detecting circumferential margin involvement with pathological large slicing,statisticsing postoperative complications rates and assessing the defecation function.Results： There were 2 cases of circumferential margin involvement.The postoperative complications included 30 cases of fecal incontinence but resumed within one week,2 cases of tumor recurrence with secondary operation,2 cases of anastomotic leakage,2 cases of anastomotic stenosis,and 1 died of postoperative liver metastasis.Defecation function indexes and manometry in rectum of the 38 patients turned to be normal after 9 months and the other 3 patients after 18 months,a patient died in the 15th month.Conclusions：Colo-dentate line anastomosis puts forward a new operation way for anus-preserving of rectal cancer.It ensures the effectiveness of radical surgery while not increases post-operative complications.Moreover,it achieves more satisfactory defecation function.