直肠不同部位进展期癌的手术原则和方法

目的:探讨直肠不同部位进展期癌患者的手术原则、手术方法及其临床意义.方法:回顾性分析96例进展期直肠癌患者的临床资料.结果:肿瘤位于腹膜返折以下者41例行全直肠系膜切除术(TME),位于腹膜返折以上者55例行宽直肠系膜切除术(WME),两组疗效相仿.行前切除术(AR)75例,腹会阴联合切除术(APR)21例,AR组与APR组术后2、3年局部复发率和3、5年生存率均无显著差别.96例行肠系膜下动脉根部结扎并清扫该动脉根部及腹主动脉前区域淋巴结(D3),肠系膜下动脉根部淋巴结(N3)转移率11.5%,N3转移阳性组和阴性组术后疗效无显著差别.行闭孔及髂内淋巴结清扫11例,2例转移.结论:上中段直肠癌只须行WME,下段直肠癌应行TME;保肛手术要以根治为前提,不可盲目追求保肛率的高低;各部位进展期直肠癌患者均应行D3式扩大淋巴结清扫,部分下段直肠癌患者应同时行侧方淋巴结清扫.

Operative Principle and Methods of Advanced Cancer in Different Parts of Rectum

Objective: To investigate the operative principal, methods and clinical significance of advanced cancer in different parts of rectum. Methods: To Analysis clinical information of 96 patients with advanced rectal cancer. Results: 41 patients with cancer under peritoneal reflection were done total mesorectal excision (TME), 55 patients with cancer at or up peritoneal reflection were done wide mesorectal excision (WME). After operation, both of them have the similar therapeutic effectiveness. Low anterior resection (AR) was done in 75 patients and assisted abdomino-perineal resection (APR) done in 21 patients, the therapeutic effectiveness was not obvious difference between the two groups. 96 patients have been done high ligation of inferior mesenteric artery and abdominal aortic artery lymph node dissection(D3), transfer rate of inferior mesenteric artery lymph node (N3) was 11.5%, the difference of therapeutic effectiveness between the N3 transfer positive group and negative group were not obvious significance. Conclusion: Superior and middle rectal cancer can use WME and inferior rectal cancer use TME. AR and APR have the same therapeutic effectiveness, Anus-retained operation must be predicated on the radical operation. Advanced rectal cancer patients should do D3 lymph node dissection, part of middle-inferior patients should do side lymph node dissection.