经肛管括约肌间径路治疗超低位直肠癌之临床疗效观察

目的：探讨经肛管括约肌间径路行超低位直肠癌根治术的安全性及临床疗效。方法：回顾性分析2004—08—2007—08在武汉协和医院接受经肛管括约肌间径路手术治疗的30例超低位直肠癌患者的临床资料；选取同期经腹-会阴联合途径行超低位直肠癌根治术且临床病理资料相匹配的30例患者作为对照组。结果：与对照组相比，经肛管括约肌间径路术式术中出血量减少、手术时间及术后ICU治疗时间缩短（均为P〈0．05），术后住院治疗时间差异无统计学意义；术后18个月时，30例患者肛管直肠测压各项指标均趋于正常。两组患者并发症发生率分别为6．7％（2／30）和10．0％（3／30），5年总体累积生存率分别为58．6％和53．3％，差异均无统计学意义。结论：经肛管内外括约肌间切除术治疗超低位直肠癌安全性高、根治效果与对照组相当、预后良好，可显著改善患者术后生活质量。

Clinical efficacy and prognostic analysis of intersphincteric resection in the sphincter-saving operation for ultra-low rectal cancer

Objective： To investigate the safety and clinical efficacy of the intersphincteric resection in the sphincter-saving operation for ultra-low rectal cancer. Method：Thirty patients with ultra-low rectal cancer who received intersphincteric resection from August 2004 to August 2007 were selected and clinicopathological data were analyzed retrospectively. The data collected were compared with those of 30 ultra-low rectal cancer patients underwent the standard Miles operation during the same period. Result： As compared with the control group, the intersphincteric resection showed less blood loss,shorter operating time and shorter ICU stay （P〈0.05 for each）, whereas no significant difference was observed on the period of hospitalization. The results of anorectal manometry indicators for 30 patients received intersphincteric resection gradually tended to be normal for 18 months after surgery. The complication rates of the intersphincteric resection group and the control group were 6.7% （2/30） and 10.0 % （3/30）, and the 5-year survival rates were 58.60% and 53.3 %, respectively. Conclusion：The intersphincteric resection is a safe and effective alternative sphincter-saving operation to improve the postoperative quality Of life for ultra-low rectal cancer patients.