经腹肛门内括约肌切除直肠癌根治保肛术治疗超低位直肠癌的临床疗效

目的探讨经腹肛门内括约肌切除保肛术治疗超低位直肠癌的临床疗效。方法选取2005年5月至2012年9月间收治的88例T1期和他期超低位直肠癌患者实施经腹肛门内括约肌切除保肛术，术后随访观察患者术后3个月、6个月及12个月的肛门括约肌功能并进行Kirwan分级，观察患者术后局部复发率、肛门括约肌功能和5年生存率。结果88例患者术后随访观察1—8年不等，平均随访时间4．3年，其中随访5年以上者36例，术后发生吻合口瘘3例（3．4％），吻合口狭窄4例（4．5％），发生应激性溃疡1例（1．1％）。随术后评估时间的延长，患者肛门括约肌功能逐渐改善，Kirwan分级水平不断减低；术后中位生存时间为80个月，5年生存率为75．0％。结论经腹肛门内括约肌切除保肛术是超低位直肠癌较理想、安全的术式，术后根治效果良好，肛门括约肌功能较满意。

The clinical efficacy of abdominal-anal intersphincteric resection with sphincter-preserving for Su- per-low rectal cancer

Objective To investigate the clinical efficacy of abdominal-anal intersphincteric resection with sphincter-preserving for Super-low rectal cancer. Methods 88 cases with super-low rectal cancer staged T1 and T2 from May 2005 to September 2012 were received abdominal-anal intersphincteric resection with sphincter-preserving, all the patients were followed up for 3 months, 6 months and 12 months of operation, the anal sphincter function and corresponding Kirwan classification were observed, as well as the rate of local recurrence, the anal sphincter function and 5-year survival. Results 88 patients were followed up from 1 year to 8 years, with an average follow-up time of 4. 3 years, among these, 36 cases were followed more than 5 years. 3 cases of patients （3.4%）developed rectal fistula, 4 cases （4. 5 % ） were anastomotic stenosis, 1 case （1.1%） was the stress ulcer; anal sphincter function gradually improved and Kirwan score reduced at 3,6,12 months postoperatively with time; the median survival time was 80 months, 5 years survival rate was 75.0%. Conclusions The abdominal-anal intersphincteric resection with sphincter-preserving for super-low rectal cancer is an ideal and safe procedure, the radical effect is excellent and the anal sphincter function is quite satisfactory.