直肠癌保肛术与Miles术临床疗效的比较分析

目的探讨比较保肛术和Miles术治疗直肠癌的临床疗效。方法对1980年1月至2006年12月572例直肠癌手术的术后并发症、复发率、转移率和5年生存率等进行回顾性对比分析。结果403例患者接受保肛术治疗,169例接受Miles术。随访时间为0．5～25．0年,中位随访时间为9．5年,随访率为76．2％（436／572）。术后总的局部复发率为6．7％（29／436）,各种保肛术式为6．3％（20／317）,Miles术为7．6％（9／119）,差异无统计学意义（x^2=1．3942,P〉0．05）。术后总的远处转移率为15．8％（69／436）,各种保肛术式为15．7％（50／317）,Miles术为16．2％（19／119）,差异无统计学意义（x^2=1．3942,P〉0．05）。术后总体5年生存率为67．6％（295／436）,其中保肛术为67．8％（215／317）,Miles术为67．2％（80／119）,套入式结肠直肠黏膜吻合保肛术为72．5％（132／182）。比较术后5年生存率套入式结肠直肠黏膜吻合保肛术略有提高,但差异无统计学意义（,=0．6672,P〉0．05）。结论直肠癌保肛术后局部复发率和5年生存率与Miles术基本相当,但患者生活质量得到明显提高。直肠癌术式应根据病变部位、生物学特性、临床分期进行个体化选择。

Clinical analysis of therapeutic effects of sphincter-preserving operation and Miles operation for rectal cancer

OBJECTIVE: To investigate and compare therapeutic effects of sphincter-preserving operation and Miles operation for rectal cancer. METHODS: A retrospective analysis was carried out in 572 cases of rectal cancer operations performed from January 1980 to December 2006. RESULTS: Sphincter-preserving operation was carried out in 403 cases and Miles procedure in 169 cases. The follow-up rate was 76.2% (436/572) with a period of 0.5 - 25.0 years (median, 9.5 years). Local recurrence occurred in 6.3% (20/317) of sphincter-preserving operation and 7.6% (9/119) of Miles operation, the differences was not significant (chi2 = 1.3942, P > 0.05). Distal metastasis was found in 50 cases (15.7%) of sphincter-preserving operation and 19 cases (16.2%) of the Miles operation with no significant difference (chi2 = 0.6672, P > 0.05). There was no significant difference in five-year survival rate between the two groups, with 67.8% in sphincter-preserving operation and 67.2% in Miles operation. CONCLUSIONS: Sphincter-preserving operations can improve the quality of life in rectal cancer although with the same five-year survival rate and recurrence rate as Miles operation. The operation for rectal cancer should be performed individually according to the location, the bionomics and the clinical stage.