中低位直肠癌根治性切除保肛术333例临床分析

目的 探讨中低位直肠癌套入式吻合和器械吻合保肛术临床疗效.方法 对333例中低位直肠癌根治性切除行套入式吻合保肛术和器械吻合保肛术两组进行回顾性临床分析.套入式吻合保肛术组231例,男137例,女94例,平均59.6岁.Dukes A期79例,B期127例,C期23例,D期2例.低位前切除器械吻合保肛术组102例,男53例,女49例,平均61.4岁.DukesA期23例,B期59例,C期16例,D期4例.333例肿瘤下缘距齿状线6~10cm.结果 333例术后随访率为84.6%(282/333),中位随访时间为6.7年.套入式吻合保肛术组随访率为85.3%(197/231),术后发生吻合口瘘8例(3.4%),吻合口狭窄3例(1.2%).前切除器械吻合保肛术组随访率为83.3%(85/102).术后发生吻合口瘘4例(3.9%),吻合口狭窄2例(1.9%、)两组术后12～24周时排便功能基本恢复到正常,1～3次/d.局部复发率,套入式吻合保肛术组和器械吻合保肛术组分别为5.1%(5/197)和5.8%(5/85 ),肝转移率为15.2%(30/197)和16.4%(14/85),肺转移率为2.0%(4/197)和2.3%(2/85),术后总体5年生存率为71.6%和69.5%.结论 套入式吻合保肛术和低位前切除器械吻合保肛术,既能保留良好的肛门排便功能,提高患者生活质量,其远期局部复发率和5年生存率与Milse手术类似,是目前常采用的保肛术式之一.

Radical excision and anal preservation in 333 cases of middle-low rectal cancer

Objective To study the clinic,efficacy of anus-preserving proce-dures by casing anastomosis of the colon and rectal mucosa and by a stapling device.Methods A retrospective analysis was made on 333 patients with middle-low rectal cancer,of whom 231 patients including 137 males and 94 females (mean 59.6 years) were subjected to the procedure of casing anastomosis.According to Dukes stage clas-sification ,79 patients belonged tp stage A,127 stage B, 23 stage C,and 2 stage D. With a stapling device,anterior excision was performed in 102 patients includinl 53 males and 49 females or 23 with stage A,59 stage B,16 stage C,and 4 stage D.Results The follow up rate was 84.6%(282/333),and the median time of follow up was 6.7 years.For the group of casing anastomosis,the follow up rate was 85.3%(197/231),and complications included stoma leak in 3(1.2%)patients and stoma stenosis in 8(3.4%).Local recurrence rate was 5.1%(5/197).The rates of hepatic and lung metastases were 15.2%(30/197)and 2.0%(4/197)respectively. The five year survival rate was 71.6%.For the group of stapling device,the follow up rate was 83.3%(85/102),and postoperative complications included stoma leak in 4 (3.9%)patiens and stoma stenosis in 2(1.9%).The local recurrence,rate was 5.8%(5/85),and the rate of hepatic and lung metastasis was 16.4%(14/85)and 2.3%(2/85)respectively.And the five year survival rate was 69.5%.Defecation in all patients in the two groups normalized in 12-24 weeks after operation,about 1-3 times per day.Conclusions Both procedures of casing anastomosis and stapling de-vice are safe and efficacious in the treatment of rectal cancer.They are useful for anus-preserving operation and keep defecation normal.With the procedures,the life quality of patients with rectal cancer can be improved,with a low local recurrence and a guar-anteed five-year survwival rate.