配合术前行放化疗直肠系膜全切除保肛治疗中低位直肠癌的疗效观察

目的探讨配合术前行放化疗直肠系膜全切除保肛治疗中低位直肠癌的可行性。方法纳入中低位直肠癌且肿瘤下缘距肛缘〉5cm的患者为观察对象，行直肠系膜全切除保肛治疗。术前行放化疗，新辅助放化疗后休息6—8周进行手术。针对不同病情分别采取低位前切除术，超低位前切除术（癌肿距肛缘5cm以内）。所有病例均术后定期化疗。结果全组病例无术中死亡。术后半年，20例排便功能基本恢复正常，为64．5％，8例排便功能较差，为25．8％，3例排便功能差，为9．7％（主要表现为无便意或大便不能控制）。术后随访1—6年，术后1年内吻合口狭窄2例。5年生存17例占54．8％，局部复发率15．4％。结论保肛手术在完善患者病情的术前评估，严格合理地选择手术适应证，配合术前行放化疗实施全直肠系膜切除术，中低位直肠癌保肛手术疗效确切。

Line with preoperative radiotherapy and chemotherapy total mesorectal excision anus treatment of low rectal cancer

Abstract] Objective Discussion with preoperative radiotherapy and chemotherapy lines total mesorectal excision anus treatment of the feasibility of low rectal cancer. Methods Incorporated in the low rectal cancer and the tumor from the anal margin of the lower edge of 〉 5 cm patients for observation object, the total mesorectal excision anus treatment. Line preoperative radiotherapy and chemotherapy, radiotherapy and chemotherapy after neoadjuvant rest 6 to 8 weeks for an operation. Taken separately for different conditions of low anterior resection ,ultra-low anterior resection（ tumor less than 5 em from the anal margin）. All patients underwent postoperative chemotherapy regularly. Results All patients died without surgery. After six months, 20 cases of bowel function returned to normal, and 64. 5 %, 8 cases of poor bowel function, was 25.8%, three cases of defecation bad for 9. 7 percent（ mainly for non-performance will be Italian or stool control）. Postoperative follow-up 1-6 years, one year after two cases of anastomotic stenosis. 5-year survival of 17 cases accounted for 54. 8%, 15. 4% local recurrence rate. Conclusion Sphincter-saving surgery to improve patients at preoperative assessment, strictly rational selection of operative indication, coupled with pre-operative radiotherapy and chemotherapy line implementation of total mesorectal excision,in low rectal cancer surgery exact anus.