摘要
目的探讨套入式结肠直肠黏膜吻合术治疗中低位直肠癌保留肛门括约肌功能的安全性和可行性。方法对中低位直肠癌经腹肛门根治性切除行套入式结肠直肠黏膜吻合术治疗的169例临床资料进行分析。169例中男107例,女62例。年龄21～99岁,平均为54.2岁。肿瘤下缘距齿状线5～9cm。病理诊断直肠腺癌163例,其中高分化者70例,中分化者81例,低分化者6例,黏液腺癌6例。腺瘤癌变6例。Dukes分期:A期61例,B期101例,C期7例。结果术后发生吻合口瘘5例(2.9%),狭窄3例(1.7%),术后早期排便次数可达6～12次/d,术后12～18周时排便功能基本恢复正常。169例术后随访率为91%,中位随访时间5.8年。局部复发率为5.8%,肝转移率为13.7%。术后总体5年生存率为66.9%,中位生存时间69(6～132)个月。结论套入式结肠直肠黏膜吻合保肛术式能达到直肠癌根治性切除,且可保留肛门正常的排便控制功能。
Objective To evaluate the safety and feasibility of sphincter-preserving transabdominal-anal excision of middle-lower rectal cancer by mucosa-mucosa coloanal anastomosis. Methods There were 169 cases undergoing this procedure including 107 males and 62 females. The low margins of the tumors located between 5 - 9 cm from the anal verge. Histopathological examination showed adenocarcinoma in 163 cases, mucinous adenocarcinoma in 6, and adenoma with canceration in 6. According to Dukes＇ classification,61 belonged to Dukes＇ A,101 Dukes＇B, and 7 Dukes＇C. Results Postoperative complications included stomal leak in 5 cases, stomal stenosis in 3, and defecation frequency increased to 6-12 times daily in all cases during the early stage and gradually back to normal 12 - 18 weeks postoperation. An average follow-up of 5.8 years was made in 154 cases（91. 1% ）. Local recurrence was 5, 8%. Hepatic metastasis was 13.7%. The five year survival rate was 66.9%. Conclusion This analsphincter preserving procedure while fulfilling radical resection for middle-lower rectal carcinoma is both safe and feasible alternative approach.
出处
《中华普通外科杂志》
CSCD
北大核心
2005年第10期622-624,共3页
Chinese Journal of General Surgery
关键词
直肠肿瘤
外科手术
结直肠切除术
重建性
Rectal neoplasms
Surgical procedures, operative
Proetoeoleetomy, restorative
