高龄直肠或肛管癌患者的两种极限保肛术式的术后近期结果的比较研究

目的比较低位／超低位前切除术和外翻切除术治疗高龄直肠或肛管癌的手术效果。方法回顾性分析2009年1月至2011年12月期间我院结直肠外科专业组收治的符合纳入条件的184例行直肠或肛管癌根治手术患者的临床资料，比较行低位／超低位前切除（低位／超低位前切除组，n=99）与外翻切除术（外翻切除术组，n=85）的术中、术后情况及并发症发生情况。结果①2组基线资料如年龄、身体质量指数、性别、肿瘤直径、TNM分期、分化程度、大体类型、组织学类型及内科合并症方面差异均无统计学意义（P〉0．05）。②外翻切除术组的肿瘤距肛距离较低位／超低位前切除术组更近P〈0．05），且远端切除距离长于低位／超低位前切除术组P〈0．05）。③2组在手术时间、术中出血量、美国麻醉医师协会分级及术后并发症方面差异均无统计学意义（P〉0．05）。④2组在拔除胃管、尿管、引流管时间及首次排气、排便、经口进食、首次下床活动时间以及总费用方面比较差异均无统计学意义（P〉0．05）；但外翻切除术组的术后住院时间和总住院时间均明显长于低位／超低位前切除术组P〈0．05）。⑤术后全部获得随访，平均随访时间13个月。随访期间，外翻切除组有1例局部复发；低位／超低位前切除组和外翻切除组各有1例远处转移；低位／超低位前切除组死亡4例（4．04％），外翻切除组死亡4例（4．71％）。2组术后复发率、远处转移率及死亡率比较，差异均无统计学意义（P〉0．05）。存活患者的肛门控便功能均恢复良好。结论低位／超低位前切除术和外翻切除术都可以应用在高龄极低位直肠癌和肛管癌患者，外翻切除术的远端切除距离长于低位／超低位前切除术，适用于位置更低的肿瘤。

Comparative Outcomes of Low/Ultra-Low Anterior Rectal Resection and Valgus Resection in Elder Patients with Rectal or Anal Cancer

Objective To compare the outcomes of low/ultra-low anterior rectal resection and valgus resection in elder patients with rectal or anal cancer. Methods The clinical data of 184 patients with rectal or anal cancer, who were treated with extreme sphincter preserving surgery in West China Hospital from January 2009 to December 2011, were collected and analyzed retrospectively. The intraoperative and postoperative indexes between low/ultra-low anterior rectal resection group and valgus resection group were compared. Results ①There were no significant differences in the age, body mass index, gender, diameter of tumor, TNM stage, degree of differentiation, histological type, gross type, and complications before operation, such as hypertension, chronic obstructive pulmonary disease, cardiovascular diseases, diabetes, renal disease, and hypoproteinemia in two groups （P〉 0. 05）. ② Compared with the low/ultra-low anterior rectal resection group, the distance from the anal verge to the tumor was shorter O~〈0. 05） and the distance of distal resec- tion margin of tumor was longer （P〈0. 05） in the valgus resection group. ③ There were no significant differences in the operation time, blood loss, ASA grade, and the postoperative complications in two groups （P〉0. 05）. ④ There were no significant differences in the duration of pulling out nasogastric tube, urinary catheter, and drainage tube, the duration of first passing flatus, first defecation, first oral intake, and first ambulation, and hospitalization cost （P〉 0. 05）. But the postoperative hospital stay and total hospital stay in the valgus resection group were significantly longer than those in the low/ultra-low anterior rectal resection group （P〈0. 05）. ⑤All the patients were followed-up for 6-24 months （average 13 months）. During the following-up, only 1 case suffered local tumor recurrence in the valgus resection group. One case suffered distant metastases in the ultra-low anterior rectal resection and valgus resection group, respectively. Eight cases （4.35%） died, of which 4 cases （4. 04%） in the low/ultra-low anterior rectal group and 4 cases （4. 71%） in the valgus resection group. All the patients were in functional recovery of anal control after operation. Conclusions As the extreme sphincter preserving surgery for elder patients with rectal or anal cancer, the low or ultra-low anterior rectal resection and valgus resection could both be used for elder patients with extreme-low rectal or anal cancer. However, valgus resection results in longer distal surgical margin than that low/ultra-low anterior rectal resection, and it is suitable for the patients with shorter distances from the anal verge to the tumor.