全直肠系膜切除术加改良Bacon手术治疗超低位直肠癌的临床研究

目的探讨全直肠系膜切除术(TME)加改良Bacon手术治疗超低位直肠癌的手术适应证和手术操作方法。方法对76例确诊为直肠癌的癌灶下缘距肛门缘4~8 cm的患者,采用自制肛门牵开器经腹腔和肛门途径行TME加改良Bacon手术。结果全组手术均成功,无手术死亡,无吻合口瘘,2例发生吻合口狭窄。术后随访76例1~5年,术后3~5个月开始恢复排便自控功能,为3~6次/d;6个月以后肛门排便功能基本恢复正常,为1~3次/d。其中5例于术后1~2年吻合口区域局部癌复发(6.58%);1,3,5年生存率分别为100%,80.83%和68.37%。结论TME加改良Bacon手术是一种治疗无远处转移的Dukes A~C期超低位直肠癌的安全有效的方法。

Clinical study of combined total mesorectal excision and modified Bacon procedure for treatment of very low rectal cancer

Objective To evaluate the operative indications and technique of combined total mesorectal excision(TME)with modified Bacon procedure for treatment of very low rectal cancer.Methods Seventy-six cases who was proven very low rectal cancer in which the distance between the anal verge and the lower margin of the tumor was 4-8 cm underwent combined abdominal and trans anal TME and modified Bacon procedure with use of self-made anal retractor.Results There was no operative mortality or anastomotic fistula,and in all cases the operation was successful.The follow-up was 1-5 years.Local postoperative recurrence developed in 5 cases(6.58 %)in 1-2 years,and 2 cases had anastomotic stenosis.The 1-,3-,and 5-year survival rate was 100 %,80.83 %,and 68.37 %,respectively.Defecation was under satisfactory control 3~6 months after operation and restored to normal in 6 months.Conclusions Combined TME and modified Bacon procedure is a safe and effective method for treatment of very low rectal cancer of Dukes stages A, B and C cases without distant metastasis.