超低位直肠癌保肛术22例临床分析

目的　探讨和研究超低位直肠癌保留肛门括约肌功能的最佳治疗术式。方法　经腹和肛门齿状线切除直肠下段癌 ,行乙状结肠与肛管齿状线吻合 2 2例。结果　全组无手术死亡、无发生吻合口漏和吻合口狭窄 ,术后 10 - 12周对排气和排便控制良好 ,无一例发生大便失禁。随访 11个月 - 8年 ,平均随访时间 3年 3个月。一、三、五年生存率分别为 13.6 % (3 2 2 )、5 9.1% (13 2 2 )、2 7.3% (6 2 2 )。 3例DukesC1期于术后 14、18个月和 2 3个月死于远处转移 ,无一例局部复发。结论　根据直肠肿瘤临床分期和肿瘤生物学行为选择手术适应证 ;经腹、肛门齿线联合切除根治下段直肠癌 ,行乙状结肠与肛管齿状线吻合是一种良好的保肛术式

To investigate the best surgical procedure for sphincter- saving resection for super- low rectal cancer

Objective To investigate the best surgical procedure for sphincter-saving resection for low rectal cancer. Methods 22 cases with low rectal cancer underwent resection of low rectal malignancy by Park's protocol, and anastomosis of signmoid and anus dentate line. Results All the patients were followed up from 11 months to 8 years. No patient died of operation. No patient was complicated with anastomosis fistula and anastomosis stricture. Fecal incontinence wasn't found in all patients postoperative 10-12 weeks. Only who were in Dukes C1 patients died of metastasis after 14, 18 and 23 months respectively, but no local recurrence was found. Conclusions Operative indiction should be chosen according to clinical stage and biological behavior of rectal malignancy. Anastomosis of sigmoid and anus dentate line after resection of low rectal malignancy by Park's protocol is a better sphincter-saving procedure.