经肛门切除内括约肌的低位直肠癌保肛术40例临床经验

目的分析在全直肠系膜切除术（TME）基础上采用内括约肌切除（ISR）治疗低位直肠癌的手术经验和初步结果。方法2000年3月至2007年3月共40例低位直肠肿瘤患者接受TME基础上的ISR治疗。手术方式：腹部手术施行TME,会阴部手术施行ISR。术后随访了解并发症、肛门功能、肿瘤局部复发和转移情况。结果本组患者手术均成功完成,无手术死亡。术后随访3个月-7年（平均34个月）,39例术后获得较好的肛门功能,Kirwan分级1—3级。1例发生吻合口瘘,2例发生伤口感染,均经保守治愈。2例术后直肠癌局部复发,其中1例死亡。结论ISR治疗超低位直肠癌安全可行,在根治的前提下可良好地保留肛门功能。

Short-term results of sphincter-preserving operation with intersphincteric resection in low rectal cancer

OBJECTIVES: To report the operative experience and sphincter-preserving results of total mesorectal excision (TME) combined with intersphincteric resection (ISR) in treating low rectal cancer. METHODS: From March 2000 to March 2007, 40 cases of patients with low rectal cancer were operated on: TME was performed transabdominally and ISR was performed transperineally. Postoperative anal function, local recurrence and metastasis were followed up. RESULTS: All of the operations were successfully completed. There was no death of operation occurred. The patients were followed-up for 3 months to 7 years (mean, 34 months). Favorable anal function was reserved in 39 patients with Kirwan grade of 1 to 3. Anastomotic leakage occurred in 1 case and wound infection in 2 cases. Two cases recurred locally after operation and one of them died. CONCLUSIONS: ISR can be safely performed in ultra-low rectal cancer, it preserves anal function well and offers radical cure.