老年中低位直肠癌保肛手术临床分析

目的]探讨老年中低位直肠癌保肛手术的临床特点和疗效.方法]1990年1月至1997年7月148例60岁以上的老年中低位直肠癌患者行直肠癌根治术,其中92例行保肛手术(老年SSR组),56例行Miles手术(老年APR组);同期86例60岁以下的中青年中低位直肠癌患者行SSR(中青年SSR组).比较3组病例肿瘤的生物学行为、术后并发症、排便功能恢复、局部复发率、远处转移率和1年、3年、5年生存率.结果]老年SSR组中高分化腺癌的比例高于中青年SSR组(p＜0.05).老年SSR组术后并发症的发生率为32.6%(30/92),稍高于中青年SSR组.老年SSR组的转移率(26.3%)、局部复发率(13.2%),低于中青年SSR组(p＜0.05);老年SSR组1年生存率(97.4%)、3年生存率(84.2%)和5年生存率(65.8%)与老年APR组相比差异无显著性,但高于中青年SSR组(P＜0.05).结论]老年中低位直肠癌由于生物学行为和生理特点,适于行保肛手术,术后复发率和转移率低于中青年患者,生存率高于中青年患者.

A Clinical Analysis of Sphincter-saving Resection for Senile Patients with Middle or Low Rectal Carcinoma

Purpose] To investigate the characteristics and effects of sphincter-saving resection(SSR)in patients with middle or low rectal carcinoma.Methods] From Jan.1990 to Jul.1997,148 senile patients(>60 years old)with middle or low rectal carcinoma underwent radical operation:sphincter-saving resection(senile SSR group,92 cases)and abdomino-perineal resection(senile APR group,56 cases).Meanwhile 86 young patients(<60 years old)underwent sphincter-saving resection(young SSR group).The biological characteristics,complications,anal defecation function,local recurrence,distal metastasis and survival rates of 1-,3-and 5-year were analyzed.Result]The moderate and high differentiated adenocarcinoma cases were more common in senile SSR group than in young SSR group(P<0.05).The complication rate in senile SSR group(32.6%)was a little higher than that in young SSR group(29.1%,P>0.05).The rates of local recurrence and distal metastasis in senile group(13.2%,26.3%)were lower than those in young SSR group(P<0.05),and the survival rates of 1-,3-and 5-year in senile SSR group(97.4%,84.2%,65.8%)were significantly higher than those in young SSR group(P<0.05).Conclusion] Senile patients with middle or low rectal carcinoma are suitable for SSR because of its biological and physiological characteristics.The rate of local recurrence and distal metastasis is lower in senile SSR group than that in young SSR group,and the survival rate is higher than that in young SSR group.