低位直肠癌的外科治疗

Surgical treatment of carcinoma of low rectum

手术治疗低位直肠癌１２３０例，切除率７９．９２％，根治性切除率６３．９８％，手术死亡率１．４２％。在根治性切除术术中，腹会阴切除术占７１．１６％，复发率１３．５７％；保留肛管括约肌功能手术占２８．８４％，复发率为１２．３３％。１９８０年后与１９８０年前相比，５年生存率提高，手术死亡率下降。结果表明，如果病例选择适当，保肛手术在低位直肠癌中无论生存率或生活质量均明显优于腹会阴切除术。

Abstract1230 cases of low rectal cancer were treated surgi-cally frorn 1954 through 1990 with a resectability rateof 79.92%and a curative resectability rate of 63. 98%。Arnong curative resections,abdomino-perineal excisionaccounted for 71.16%and sphincter-saving resectionfor 28.84%。 Before 1980, 19. 19%cases were treatedwith SSR and since 1980 it was raisen to 41. 04%。 Incomparison of the results of group before 1980 withthose since 1980,the mortality rate of curative resec-tion was 1.56%and 0. 99%respectively. The 5-yearsurvival rate of curative resection(life table method)was 58.96%±2. 87%in APR and80. 39%±5. 06%inSSR before 1980,and 71. 65%±3. 28%in APR and83. 82%±3. 46%since 1980.The local recurrence af-ter curative resection was 13. 57%in APR and 12. 33%in SSR.The data showed that in properly selected cas-es,the outcome was better in SSR than in APR eitherin survival or in quality of life. The feasibility and rea-sonality of the SSR and the rules for selecting the oper-ative procedures in low rectal cancer were discussed indetail。