直肠癌根治术保留肛门功能临床研究

Clinical Study on Preservation of Anus Function in Radical Resection of Rectal Cancer

本文针对中、下段直肠癌，在不影响根治原则的基础上，设法保留或重建肛门功能，避免腹壁造瘘的手术。自1995年8月～2004年10月，共施行直肠癌根治术86例，其中行保肛手术48例。就临床观察，术后肛门功能恢复情况，以低位前切除术最佳，股薄肌移植术若手术成功，功能恢复亦称满意。许多学者曾经将Dixon手术改良演变成其他多种术式如各种拖出式吻合，但吻合器可以完成在直肠、肛管任何位置的吻合，所以结肠拉出术在临床上较少采用。适应证选择应以早中期、病变局限、深度不超过肌层，术中探查无明显区域淋巴结转移的高、中分化腺癌为主。依据病变占居部位，采用不同的手术方式。

The theme of this article lies in how to preserve the anus or restore the anal function in the treatment of middle or lower rectal cancer in order to avoid abdominal artificial anus, on the basis of not violating the principles of radical resection. From August 1995 to October 2004, 86 cases of rectal cancer were operated with radical resection, 48 of which preserved anus. Based on close observation of the patients, pustoperative anal function seems the best in those with Dixon＇s anterior approach. if transplantation of the gracilis muscle is successful, satisfactory function restoration is always possible. Many scholars ever reformed Dixon＇s resection with lots of operative procedures, such as Bacon＇s resection. Because stapler can join rectal and anal together at any location, Bacon＇s resection is seldom adopted in clinical practice. The indications for anus preserving operation are as follows： ① early or middle stage disease with localized lesion not invading beyond the muscle layer of the bowel; ② no metastatic regional lymph adenopathy and; ③ adenocarcinoma at high or moderate degree of differentiation. It is suggested that different types of operative procedures are adopted according to the location of the lesion.