超低位直肠癌保肛手术后肛门直肠功能变化的研究

目的探讨超低位直肠癌患者行保肛手术后肛门直肠功能的变化。方法回顾性分析32例超低位直肠癌患者施行保肛手术的临床资料,于手术前及手术后3个月、6个月、12个月分别采用肛管直肠压力测定方法和徐忠法肛门功能检测标准进行肛门直肠功能评估。结果所有患者术后肛门排便功能明显下降,其中以术后3个月内肛门功能最差,术后6个月、12个月肛门功能逐渐恢复。肛管静息压、肛管最大收缩压、肛管最大收缩时间、肛管直肠抑制反射消失数在术后3个月、6个月与术前相比,差异均有统计学意义(均P0.05);术后3个月、6个月、12个月各组间比较,差异也均有统计学意义(均P0.05);术后12个月与术前相比差异无统计学意义(P0.05)。结论超低位直肠癌行保肛手术后早期肛门功能明显下降,但随着时间的推移,大多数肛门功能可逐渐恢复。对超低位直肠癌患者施行保肛手术是可行的。     

低位直肠癌保肛手术进展

直肠癌是消化道常见的恶性肿瘤之一,随着对直肠癌淋巴转移的重新认识、全直肠系膜切除和自主神经保留技术应用以及吻合器和腹腔镜在低位直肠癌的应用,拓宽了低位直肠癌保肛手术的范围。     

超低位直肠癌保肛手术对肛门功能影响的临床研究

目的 探讨超低位直肠癌保肛手术对肛门功能的影响.方法 选择2015年7月至2018年7月深圳市人民医院诊治的63例超低位直肠癌手术患者为研究对象,根据手术方式将患者分为三组:A组实施开腹直肠癌前切除术或内括约肌间切除术,B组实施腹腔镜下直肠癌前切除术或内括约肌间切除术,C组术前给予新辅助放化疗.按照相应标准进行疗效评价...     

低位直肠癌保肛手术12例

作者选择性保肛手术治疗低位直肠癌12例,术后随访8个月至5年,肛门功能良好,无手术并发症。     

低位直肠癌行保肛手术的体会

目的为提高低位直肠癌保肛手术的治疗效果,减少术后局部复发,免除因人工肛门给病人造成的痛苦。方法对５７例肿瘤位于盆底腹膜返折处或以下的低位直肠癌保肛手术进行回顾性分析。其中行Ｄｉｘｏｎ前切除术４７例,Ｂａｃｏｎ拖出术２例,Ｐａｒｋｓ结肠肛管吻合术２例,经腹骶直肠癌切除术２例,经肛门局部切除术４例。结果术后局部复发者１４例占２４．７％,局部复发中盆腔内复发９例,吻合口复发２例,腹股沟淋巴结转移１例,会阴部及坐骨直肠窝内复发２例。术后肝转移６例,肺转移２例,骨转移１例。五年无瘤生存率为６４．９％。结论对于低位直肠癌只要满足根治性手术切除的条件应尽可能争取行保肛手术。距肿瘤边缘２－３ｃｍ切断直肠是安全可靠的。强调适当扩大盆腔内切除范围是减少术后局部复发的关键。     

超低位直肠癌保肛手术的可行性研究

目的：探讨超低位直肠癌保肛手术的可行性和手术方式。方法：对我院2001年1月-2002年10月15例超低位直肠癌(肿瘤下缘距肛缘≤5cnl者)保肛手术的临床病理学特点、手术方式、术后肛门功能及预后情况进行分析。结果：本组15例，男性6例，女性9例；肿瘤距肛缘4cm者4例，4．5cm者5例，5cm者6例；病理类型属中分化腺癌者12例，中-低分化腺癌3例。均行经歧全直腑系膜切除、结肠肛门吻合术．Dukes’分期：A期8例，B期2例，C期5例。随访7个月～28个月，1例术后20个月盆腔淋巴结转移再手术，1例术后18个月发现肝肺转移化疗中。无局部复发，目前均存活。肛门功能，2个月～3个月恢复预感便意，5个月～6个月恢复控便能力，平均每天排便3次～4次．术后6个月排便节制优良率达80％。无肛门失禁。结论：对于肿瘤病灶局限、分化良好、患者情况良好。同时具备相当的手术经验，超低位直肠癌的保肛手术是可行的。     

直肠癌保肛系列问题探讨

直肠癌是常见的消化道恶性肿瘤之一。近年来其发病有增高趋势,我国直肠癌的特点之一是中低位直肠癌多见,约占全部直肠癌的70%[1]。随着现代肿瘤外科的进展和综合性治疗进步,直肠癌根治术要求一方面对肿瘤进行彻底切除,另一方面尽量保留肛门,提高病人的生活质量。因此直肠癌保肛     

低位直肠癌保肛手术的质量控制

 随着对盆腔解剖和直肠癌生物学特性认识的加深,越来越多的低位直肠癌患者能够保留肛门,保肛手术已成为目前临床上治疗直肠癌最常用的术式。高质量的手术需要同时在肿瘤学和功能学方面使患者受益,因而低位直肠癌保肛手术需兼顾肿瘤根治和肛门功能。全直肠系膜切除（total mesorectal excision,TME）原则、安全的远切缘和环周切缘是保证肿瘤学效果的关键,能够有效降低直肠癌局部复发率和远处转移率。而保留更多的肛门括约肌以及术中对盆腔植物神经的保护则是改善术后肛门功能,提高患者生活质量的重要因素。       

低位直肠癌保肛手术的改进

目的总结利用支撑管行低位直肠癌保肛术的经验和体会。方法对24例利用支撑管行低位直肠癌保肛术病例进行回顾性分析。结果全组病例顺利完成手术，术后出现吻合口漏1例，吻合口狭窄3例，随访时间平均80个月，局部癌复发2例。结论利用支撑管行低位直肠癌保肛术安全可行，具有良好的临床应用价值。     

腹腔镜低位直肠癌保肛手术新进展

低位直肠癌在我国发病率逐年上升,严重威胁着人民的健康。外科手术是低位直肠癌最有效的治疗方法,随着对直肠解剖生理和低位直肠癌生物学特点研究的不断深入,低位直肠癌保肛手术得到越来越广泛的应用,尤其腹腔镜技术的应用已成为当前关注的热点问题之一。腹腔镜低位直肠前切除术、腹腔镜低位直肠前切除术联合经肛门括约肌间切除或经肛门直肠脱出外翻等术式是腹腔镜下低位直肠癌切除保肛手术可选的手术方法。消化道重建可选择双吻合器法、手工经肛结肠肛管吻合以及结肠J型储袋成形吻合等方式。各种术式有其特有的适应范围和优缺点,应以优先保证手术根治同时兼顾生活质量为原则合理选择术式。      

26例低位局部进展期直肠癌术前加量IMRT临床观察

目的 探讨低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案的可行性及治疗效果。方法 选取2015-2016年301医院26例局部晚期直肠癌患者,肠镜下肿瘤下缘距肛缘5 cm内。放疗剂量分割模式:直肠肿瘤及转移淋巴结为58.75 Gy分25次(2.35 Gy/次),盆腔淋巴引流区为50 Gy分25次,同步卡培他滨化疗(825 mg/m²,2 次/d,5天/周)5周。同步放化疗结束后休息1周,继续辅以1个周期卡培他滨化疗(1250 mg/m²,2 次/d,连续14 d)。同步放化疗结束后6~8周行直肠TME。研究主要终点为获得ypCR及保肛手术率,次要终点为急性放化疗反应、TN降期率及术后并发症。结果 26例患者均完成新辅助放化疗,其中25例患者已行手术治疗,1例患者因肛周水肿无法手术。术后ypCR率达32%(8/25),保肛手术率为60%(15/25);TN总降期率为92%(23/25),R0切除率为100%。放化疗期间24例患者发生1、2级不良反应,2例患者发生3级放射性皮炎,未见≥4级急性不良反应。术后输尿管损伤1例,肠梗阻1例。结论 低位直肠癌患者行术前同期加量IMRT联合卡培他滨化疗方案安全可行,ypCR、R0切除率及保肛手术率达到了预期效果,长期生存是否获益有待今后进一步研究。临床试验注册 中国临床试验注册中心,注册号:ChiCTR-ONC-12002387。     

The importance of MRI for rectal cancer evaluation

Magnetic resonance imaging (MRI) has gained increasing importance in the management of rectal cancer over the last two decades. The role of MRI in patients with rectal cancer has expanded beyond the tumor-node-metastasis (TNM) system in both staging and restaging scenarios and has contributed to identifying “high” and “low” risk features that can be used to tailor and personalize patient treatment; for instance, selecting the patients for neoadjuvant chemoradiation (NCRT) before the total mesorectal excision (TME) surgery based on risk of recurrence. Among those features, the status of the circumferential resection margin (CRM), extramural vascular invasion (EMVI), and tumor deposits (TD) have stood out. Moreover, MRI also has played a role in surgical planning, especially when the tumor is located in the low rectum, when the relationship between tumor and the anal canal is important to choose the best surgical approach, and in cases of locally advanced or recurrent tumors invading adjacent pelvic organs that may require more complex surgeries such as pelvic exenteration. As approaches using organ preservation emerge, including transanal local excision and “watch-and-wait”, MRI may help in the patient selection for those treatments, follow up, and detection of tumor regrowth. Additionally, potential MRI-based prognostic and predictive biomarkers, such as quantitative and semi-quantitative metrics derived from functional sequences like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE), and radiomics, are under investigation. This review provides an overview of the current role of MRI in rectal cancer in staging and restaging and highlights the main areas under investigation and future perspectives.     

直肠癌患者放化疗相关肛门功能研究现状

近年来,随着直肠癌治疗模式的发展,直肠癌患者的保肛率逐渐提升,除了需要保留肛门外形,肛门功能的保全也逐渐受到重视。本文对直肠癌放化疗后肛门功能相关研究的文献进行综述,阐述直肠癌患者肛门功能的评价标准和研究现状。     

Anal Sphincter Function after Intersphincteric Resection for Low Rectal Cancer

Objective:To assess the anal sphincter function after intersphincteric resection for low rectal cancer by questionnaire and vectorial manometry.Methods:twenty five patients underwent intersphincteric resection,the controls contained 25 patients of rectal cancer who underwent low anterior resection and 25 healthy people.The therapeutic responses were evaluated using the Vaizey and Wexner scoring systems and vectorial manometry.Results:The Vaizey and Wexner scores after intersphincteric resection were significantly higher than those of low anterior resection controls at one month,but had no significant difference one year after.On the other hand,the indexes of vectorial manometry still had significant difference one year later.The indexes after intersphincteric resection could not reach the normal level.Conclusion:The anal sphincter function after intersphincteric resection is lower than that after low anterior resection in short term,although the long-term results can be accepted,it still can not reach the normal level.     

术前放化疗对局部晚期中低位直肠癌疗效和预后的影响

目的探讨术前放化疗对局部晚期中低位直肠癌疗效和预后的影响。方法对103例行根治术治疗的局部晚期中低位直肠癌患者的临床资料进行回顾性分析。患者均接受术前放疗,中位剂量40 Gy/4-5周。57例患者放疗的同时给予5-氟尿嘧啶或希罗达化疗2个周期,休息4～6周后手术。59例患者行保肛手术,44例行腹会阴联合切除术。生存率的计算采用Kaplan-Meier法,生存率比较采用Log rank检验,多因素分析采用Cox模型。结果术前放疗和放化疗后总的病理完全缓解率为9.7%,共有27例患者降期,降期率为26.2%。83例治疗前评价难以保肛的低位直肠癌患者中,40例成功完成了保肛术,转化率为48.2%,全组保肛率为57.3%。3年总生存率和无病生存率分别为66.3%和59.5%。单因素分析表明,放化疗后病理反应及术后分期与生存率有关;多因素分析结果显示,生存期仅与术后分期有关。结论术前放疗或放化疗有利于提高局部晚期中低位直肠癌的保肛率,采用保肛术与腹会阴联合切除木的局部控制率和生存率相似。     

Evaluation of anal function after surgery for rectal cancer

BACKGROUND AND OBJECTIVES: Sphincter-saving surgical procedures for rectal cancer have been legitimized if executed respecting the criteria of oncological radicalness. Our objective was to evaluate anal sphincteric continence after rectal cancer surgery. METHODS: A detailed questionnaire regarding continence was administered to 3 groups of patients. Group 1 was composed of 9 patients treated with a higher (>4 cm), stapled colorectal anastomosis; the 9 group 2 patients were treated with a low (< or =4 cm), stapled colorectal anastomosis; the 9 group 3 patients underwent coloanal anastomosis. RESULTS: The results were evaluated about 3 years after surgery. Continence was excellent in group 1 and very good in group 2. However, in group 3, we observed diminished gas/feces discrimination, reduced ability to postpone evacuation, and increased soiling and perianal rash. CONCLUSIONS: Anal sphincteric continence was better after surgery with a high or low colorectal anastomosis than after coloanal anastomosis.     

Robotic surgery for rectal cancer: A systematic review of current practice

AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery.METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”.RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m² were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery.CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.     

Unexpected rectal cancer after TEM: Outcome of completion surgery compared with primary TME

Background

Transanal endoscopic microsurgery (TEM) has gained wide-spread acceptance as a safe and useful technique for the resection of rectal adenomas and selected T1 malignant lesions. If the lesion appears >T1 rectal cancer after resection with TEM, a completion TME resection is recommended. The aim of this study was to investigate the results of TME surgery after TEM for rectal cancer.

Methods

In four tertiary referral hospitals for TEM, all patients with completion TME surgery after initial TEM were selected. All eligible patients who were treated with 5 × 5 Gy radiotherapy followed by TME surgery from the Dutch TME trial were selected as reference group.A multivariate logistic regression model was used to calculate odds ratio's (OR) for colostomies and for colo- and ileostomies combined. Local recurrence and survival rates were compared in hazard ratio's (HR) using the multivariate Cox proportional hazard model.

Results

Fifty-nine patients were included in the TEM-COMPLETION group and 881 patients from the TME trial. In the TEM-COMPLETION group, 50.8% of the patients had a colostomy compared to 45.9% in the TME trial, OR 2.51 (p < 0.006). There is no significant difference when ileo- and colostomies are analyzed together. In the TEM-COMPLETION group, 10.2% developed a local recurrence compared to 5.2% in the TME trial, HR 6.8 (p < 0.0001).

Conclusions

Completion TME surgery after TEM for unexpected rectal adenocarcinoma results in more colostomies and higher local recurrence rates compared to one stage TME surgery preceded with preoperative 5 × 5 Gy radiotherapy. Pre-operative investigations must be optimized to distinguish malignant and benign lesions and prevent avoidable local recurrence and colostomies.     

新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响

目的:探讨新辅助放化疗对局部进展期直肠癌保肛术后排便功能的影响。方法:回顾性分析2013年至2016年我院185例局部进展期直肠癌行直肠低位前切除术患者的临床和病理资料,采用低位前切除综合征（LARS）评分量表评估患者术后排便功能状况,通过单因素和多因素Logistic回归分析影响患者术后排便功能的危险因素。结果:所有患者均严格遵循直肠全系膜切除术（TME）原则行低位前切除术,其中113例行术前（新辅助）放化疗,50例行术后（辅助）放化疗,22例未行放化疗。术后12～48个月中,患者中LARS的发生率为64.9%,重度LARS的发生率为31.9%,重度LARS患者占全部LARS患者的49.2%。单因素分析发现,接受放化疗者术后重度LARS发生比例显著高于未接受放化疗者（P＜0.001）,肿瘤距肛缘距离＜5 cm者术后重度LARS发生比例显著高于≥5 cm者（P=0.001）,开放手术者术后重度LARS发生比例显著高于腹腔镜手术者（P=0.038）,然而放化疗的不同时机（新辅助、辅助）、新辅助放化疗的不同形式（长程放化疗、短程放疗）对术后重度LARS发生比例的影响,差异并无统计学意义（P＞0.05）。多因素分析发现,只有放化疗（P=0.001）、肿瘤距肛缘距离＜5 cm（P=0.003）是术后发生重度LARS的独立危险因素。结论:LARS是直肠癌保肛术后长期困扰患者的常见并发症,放化疗、肿瘤位置较低是导致术后LARS的独立危险因素。然而,新辅助放化疗与辅助放化疗,长程放化疗与短程放疗对术后LARS发生的影响基本相似。