括约肌间切除术在超低位直肠癌保肛手术中的应用

目的评价超低位直肠癌行括约肌间切除手术(ISR)后的肛门功能及肿瘤根治效果。方法近7年间本院为1 6例超低位直肠癌患者施行ISR手术。经腹按照TME原则游离直肠至肛提肌平面后,经肛门于括约肌间沟处切开肛管皮肤,分离内括约肌直至将直肠及内括约肌全部切除,再行结肠肛管吻合。术后7 d天开始肛门收缩功能锻炼,4周开始生物反馈训练。对Dukes B,C期患者,术后2周开始化疗,术后4周进行放疗。结果全组无术后死亡,无吻合口瘘。2例术后发生结肠黏膜脱出,2例肛管狭窄,1例切口脂肪液化。随访3个月至7年,无盆腔或吻合口局部复发;2例分别于术后1 7个月和2 1个月死于肝转移,1例术后6个月死于肺转移。按W illiams的排便自制标准,术后3,6,12个月分别有6 2.5%,8 0.0%,8 4.6%的患者达到功能良好效果。结论ISR手术并发症少,安全性高,肿瘤根治效果与排便功能的恢复满意。

Experience in use of intersphincteric resection during anus-preserving operation for very low rectal cancer

Objective To evaluate the results of anal function and oncologic effect of intersphincteric resection(ISR) for very low rectal cancer Methods Sixteen patients who had ISR from March 1999 to March 2006 in our hosptal.After complete dissection of the rectum and mesorectum down to the pelvic floor,the internal sphincter was separated from the external sphincter and puborectalis and resected together with the rectum,then the coloanal anastomosis was performed.On postoperative day 7,the anal contraction function training was started;on week 4,biofeedback training was started;on week 2,chemotherapy was used for Dukes B,C stage,and on week 4 radiotherapy was used.Results There was no operative mortality,and no anastomotic leakage.Colonic mucosa prolapse developed in two patients,two developed late strictures of the coloanal anastomosis and one had wound problem.At follow-up of 3 months to 7 years,there were 2 deaths from liver metastasis and 1 death from lung metastasis;no patient developed local recurrence.According to Williams continence status level,acceptable postoperative anal function were obtained in 62.5 %,80.0 %,and 84.6 % of patients at 3,6,and 12 months respectively.Conclusions ISR is safe for selected patients with very low rectal tumor,operative morbidity is low,and the curability rate and anal functional results are satisfactory.