保留肛门的扩大根治术在低位直肠癌中的应用

Application of anus-preserving extended radical operation in low rectal cancer

目的 探讨扩大根治术在低位直肠癌保肛手术中的临床意义。方法 对 2 82例低位直肠癌实施保肛手术 ,对其中13 6例行扩大根治术 ,另 14 6例行一般根治术。结果 一般根治组 :总转移率 48.6%。N1 淋巴结转移率 44 .5 % ,N2 淋巴结转移率2 6.0 %。转移度 19.7%。扩大根治组 :总转移率 5 0 .7%。N1 淋巴结转移率 46.3 % ,N2 淋巴结转移率 2 5 .7% ,N3淋巴结转移率5 1% ,侧方淋巴结转移率 13 .2 %。转移度 15 .1%。两组未见下方淋巴结转移。术后随访结果 :一般根治组 3年生存率 72 .3 % ,局部复发率 14 .1% ;扩大根治组 3年生存率 81.7% ,局部复发率 5 .3 %。排便功能 :一般根治组优 83 .6% ,尚可 11.6% ,差 4.8%。扩大根治组优 83 .1% ,尚可 11.0 % ,差 5 .9%。结论 扩大根治术可有效防止低位直肠癌保肛术后局部复发 ,术后排便功能良好 ,不增加手术合并症。

Objective To discuss clinical significance of extended radical operation in anus-preserving operation for low rectal cancer. Methods An anus-preserving operation was performed on 282 patients with low rectal cancer, of which 136 patients underwent the extended radical operation and the rest 146 patients underwent general radical operation. Results For general radical operation group, the total metastasis rate was 48.6%; in detail, N 1 metastasis rate of lymph node was 44.5% and N 2 metastasis rate of lymph node was 26.0% with metastasis degree of 19.7%. For extended radical operation group, the total metastasis rate was 50.7%; in detail, N 1 metastasis rate of lymph node was 46.3% with 25.7% of N 2 lymph node metastasis and 5.1% of N 3 lymph node metastasis. The metastasis rate of lateral lymph node was 13.2% and the metastasis degree was 15.1%. There was no lymph node metastasis observed in both groups. Postoperative follow-up result: three-year survival rate of general radical operation group and extended radical operation group was 72.3% and 81.7%, respectively, with the local recurrence rate of 14.1% and 5.3%, respectively. As for general radical operation group, the patients with excellent defecation function accounted for 83.6%, with less excellent for 11.6% and bad for 4.8%; as for extended radical operation group, the patients with excellent defecation function accounted for 83.1%, with less excellent for 11.0% and bad for 5.9%. Conclusion The present shows that extended radical operation will effectively prevent low rectal cancer from local recurrence and yield a good defecation function after anus-preserving operation without any complications increased.