低位直肠癌术式的选择及其疗效评价

 目的 比较保肛与非保肛的几种低位直肠癌手术术后局部复发率及5年生存率的差异，探讨术式的选择。方法 收集我院1994—2000收治254例低位直肠癌病例资料，按局部切除术、TME+Dixon术、TME+Miles术分成三组，对其术后局部复发率及5年生存率进行回顾性分析。结果 局部切除组32例，行TME+Dixon术192例，TME+Miles术30例，总手术保肛率88．2％(224／254)。其中局部切除术组2年内局部复发5例，复发率15．6％，5年生成率100％；TME+Dixon术组2年内局部复发32例，复发率16．7％，5年生成率75．5％(145／192)；TME+Miles术组2年内局部复发6例，复发率20％，5年生存率46．7％(14／30)。三组病例的2年局部复发率接近，统计学数据显示无显著性差异(P>0．05)。结论 对病例下缘距肛缘3-7cm的低位直肠癌可根据病灶大小、病理类型及Dukes分期等把握术式选择的适应症，保肛术式为首选，Miles术应视为最后的选择。

Comparison of Local Recurrence Rate and Livability of Low Rectum Cancer after Operation

Objective To compare local recurrence rate (LRR) and 5-year livability of three different operations on low rectum cancer with or without anal sphincter preservation and to discuss the choice among them three. Methods The history of 254 patients with low rectum cancer was collected and divided into three groups depending on the method of surgical treatment. Study their LRR and 5-year livability retrospectively. Results Local excision group, 32 patients; Dixon with Total Mesorectal Excision(TME) group, 192 patients; Miles with TME group, 30 patients. The total rate of anal sphincter preservation is 88.2%(224/254), and the LRR of tumor in group 1 is 15.0% with 5 recurrent cases in 2 years and 100% 5-year livability; 16.7% in group 2 with 32 recurrent cases and 75.5% 5-year livability, 20% in group 3 with 6 recurrent cases and 47.7% 5-year livability. There is no statistic difference between their LRR(P> 0.05). Conclusion We choose different operation method according to the size of the tumor, pathologic style and the Duke stage of the low rectum cancer. Operations with anal sphincter preservation were chosen in most cases. Miles is no longer the have-to-do operation on patients with low rectum cancer.