低位直肠癌保肛手术的体会

The Experience of Low Rectal Cancer With Preservation of The Anus

目的：探讨低位直肠癌保肛术的手术范围及保肛术式，结肛吻合附加J形结肠袋或结肠成形对术后早期肛门功能的影响。方法：对我院1995-2003年低位直肠癌保肛术71例的临床资料进行回顾性分析。结果：实验组和对照组远端肠管切缘平均阳性率分别为13．51％和41．15％，局部复发率分别为13．51％和58．82％．实验组侧方淋巴结阳性率为32．43％；Dixon术、Parks术和各种拖出式术的术后早期平均排便次数分别是2．1次／d、4．7次／d、6.4次／d，排便紧迫感占45％、72％、84％，大便失禁率为22％、38％％、43％。结论：低位直肠癌按分类确定手术范围有利于根治性切除，TME可降低术后局部复发率,结肛吻合附加J形结肠袋或结肠成形术后早期可获得良好肛门功能，术后早期肛门功能以Dixon术最优，Parks术次之，各种拖出式术较差。

Objective： To investigate the surgical scope of low rectal cancer with preservation of anus and the influence of colon-anus anastomosing adding to colic pouch or colic-shaped to anus function at forepart after the surgery. Methods： All 71 cases of low rectal cancer anus-preservation were analyzed retrospectively, from 1995 to 2003 in my hospital. Results： The average positive rate of incisal margin for posterior intestinal canal of experiment team and control group were 13.51% and 41.15%, respectively. The partly recrudescent rate were 13.51% and 58.82% respectively. The positive rate of lateral lymph node of Experiment team is 32.43 %. The defecation at forepart after the Dixon surgery, Parks surgery and many kinds of drag-out surgeries respectively were 2. 1, 4.7, 6.4 times per day. The sense of urgency for defecation were 45%, 72%, and 84%. Incontinence rate of defecation were 22%, 38%, and 43%. Conclusion：According to the kinds of low rectal cancers, to ensure the surgical scope is good for the radical resection. TME can reduce the partly recrudescent rate after surgery. The colon-anus anastomosing adding to colic J pouch or at forepart after colic-shaped surgery, it can have good anus function. Dixon is superior technique to anus. Parks technique takes the second place, and the inferior are serious of draw-out surgeries for the anus.