直肠癌外科治疗及其疗效

总结我院１９７５年６月～１９９１年１２月手术治疗直肠癌１００２例，其中单纯造瘘术１０５例，姑息性手术１０４例，一般根治术４９１例，扩大根治术３０２例。分析结果如下：直肠癌淋巴转移率为４５．３％，转移度８．９％。上方途径第三站转移率为１０％，而侧方转移仅发生于腹膜返折以下的癌，侧方第三站转移率为１０％。因此我们主张按此淋巴转移规律进行扩大淋巴清除术，其中５年生存率达６８％，１０年生存率达４７％，生存率明显高于其他术式（Ｐ＜０．０１）。通过直肠癌壁内逆向浸润研究，指出逆向浸润的平均距离为２．４ｃｍ，并以此规律指导直肠癌的保肛手术。对直肠癌术后局部复发、肝转移、早期癌及功能性直肠癌手术提出了外科治疗原则，得到良好效果。

Surgicial Treatment of Rectum Cancer and Its Result

From June 1975 through Dec.1991,1002 case of rectum cancer treated by surgery were analyzed.Among them,mere colostomy was performed in 105 cases,palliative resection in 104 cases,radical resection in 491 cases, and extensive radical operation in 302 cases.The lymph node involvement was found in 45.3% of cases and 8.9% of the nodes dissected.Lymphatic metastasis at the third station via the upper pathway occurred in 10% of cases,hilst metastasis via the lateral pathway to the third station was encountered in 10% of cases with lesion below the level of the peritoneal reflectoin shelf. Therefore it followed that extensive radical operation with lymph node dissection along this line resulted in 5-and 10-year survial rates of 68% and 47% which were better than otherwise (P<0.01).On studying the surgical specimens, it was revealed that downward infiltration along the rectal wall was approximately 2.4cm and that preservation of the anus is justifiable.