直肠全系膜切除及保肛术在直肠癌中的应用

目的探讨中、低位直肠癌根治术中直肠全系膜切除后保留肛门的可行性、保肛术的适应证及维持术后肛门功能的可能性。方法回顾性总结了1998年10月～2004年10月保留肛门的中、低位直肠癌根治术72例,讨论保肛手术的可行性、术后直肠感觉及肛门功能恢复的可能性,提出保肛手术的适应证。结果98.6%(70/72)的病人下切缘无癌浸润。术后2年内局部复发率为2.8%(3/72)。90.2%(64/72)的病人恢复顺利,术后直肠感觉及肛门功能恢复较满意。结论保肛手术能提高术后生活质量,只要掌握好手术适应证及做到根治性切除,效果是良好的。

Application of rectal total mesorectal excision and sphincter-preserving surgery in rectal cancer

Objective To explore the feasibility and indication of sphincter-preserving surgery after rectal total mesorectal excision and the probability of preserving the function of sphincter after sphincter-preserving surgery in the radical resection of middle and low rectal cancer.Methods 72 cases,which were operated with rectal total mesorectal excision and sphincter-preserving surgery in the radical resection of middle and low rectal cancer from Oct,1998 to Oct,2004,were retrospective summarized.And then the feasibility of sphincter-preserving surgery and the postoperative feeling of rectum and the probability of recovery of sphincter function were discussed.Results 98% patients(70/72)had not found cancer cell infiltration in the incisal edge,and the part recurernce rate was 2.8%(3/72)within 2 years after operation,and 92%(64/72)patients recovered smoothly and satisfied with the feeling of rectal and the recovery of anal function.Conclusion The sphincter-preserving surgery can improve the postoperative quality of life and have a good effect,if we can grasp the indication of operation correctly and complete radical resection.