直肠中下段癌经腹肛门切除后经肛门结肠直肠粘膜吻合术

目的为探讨直肠中下段癌保留肛门临床最佳治疗术式。方法对1993年～1997年收治28例中下段直肠癌经腹肛门切除后经肛门行结肠直肠粘膜吻合术。结果随访6～52个月,平均29个月。无手术死亡率,无吻合口漏和吻合口狭窄发生。仅1例于术后19个月局部癌复发(3.6%),余27例现仍无瘤生存。术后8～12周时排便控制良好,次数为2～3次/日,18周时肛门排便功能基本恢复正常,排便次数为1～2次/日。结论合理选择手术适应症,既要避免腹壁结肠造口,又要保证手术的彻底性,在提高患者生活质量的同时,还要注重远期效果。

Abdominal-anal excision and colorectal anastomosis per anus for the treatment of middle-low rectal cancer

Objective To study the clinical optimal surgical manner of anus reserve operation for middle-low rec- tal cancer.Methods 28 cases of middle-low rectal cancer were treated with abdominal-anal excision and colorectal anatomosis from 1993 to 1997.The follow-up survey was performed for 6 to 52 months.Results There were no operative mortality and anastomotic leakage,and no anastomotic stenosis.Only one case had a local recurrence (3.6 %).27 cases had tumor-free survival up to now.The control of defecation was fine after 8 to 12 weeks of the operation,2 to 3 times each day.The defecation function recovered normally at 18 weeks after operation,1 to 2 times per day.Conclusion The author holds that a colostomy on abdominal wall can be avoided and the radical operation can be guaranteed if a select indication of the operation is reason- able.The patient's living quality improvement should be concerned as well as the late results.