切除括约肌的低位直肠癌保肛术

目的：探讨全切除内括约肌和部分外括约肌仍保留肛门控制能力的低位直肠癌根治术。方法：自1991年7月至1994年12月对12例拒绝做腹壁人工肛门的低位直肠癌患者行直肠癌切除结肠肛管吻合术。9例肿瘤位于极靠近齿线的齿线上方，3例肿瘤达齿线。把直肠段翻转拖出肛门，在肛门外施行肛管及肛周组织的横断切除和结肠肛管的吻合。结果：肠管远端的切缘在齿线上0．2cm至齿线下1cm的范围，标本的远端切缘均为阴性。术后无并发症，临床随访显示全部病例肛门控制能力良好，生活正常。随访期间未发现局部病灶复发。结论：证实了完全切除内括约肌和部分外括约肌能保留肛门控制能力以及对特别低位的直肠癌施行根治性的保肛术的可行性。这种术式具有操作相对简单而不需要暂时性的回肠或结肠造瘘的优点，还适于肥胖及窄长骨盆患者。

Removal of the Anal Sphincters in Restorative Coloanal Resection for the Low Rectal Carcinoma

Purpose: To evaluate preserving continence of resection of entire internal sphincters and partial extrasphincters in low rectal carcinoma patients. Metheds: From July 1991 to September 1994, 12 Patients underwent restorative coloanal resection. Among them, the tumors closed to dentate line in 9 patients, tumors reached lower edge of dentate line in 3 patients. Results: All the surgicalsamples 0. 2cm above and 1cm below the dentate line were negative pathologically. No complication was found after operation. All the cases revealed excellent anal function with normal daily life. None of the patients had local recurrence. Conclusions: Removal of entire internal sphincters and partial extrasphincters can preserve continence, and restorative coloanal resection for the patients with the speciallow rectal carcinoma. This approach is relatively simple to perform. A temporary ileostomy or colostomy is not necessary. It can be performed in obesity or a narrow pelvic patient.