Kraske术在直肠肿瘤保肛治疗中的应用

The Application of Kraske's Procedure in the Anus-preserving Treatment of Rectal Tumors

目的探讨改良Kraske经骶尾后入路手术在中低位直肠肿瘤保肛治疗中的应用及其适应证。方法回顾性分析江苏省肿瘤医院普外科结直肠外科1997年11月-2005年11月应用该手术方法治疗的31例中低位直肠良恶性肿瘤的临床资料。结果全组31例患者中，直肠腺癌14例，直肠类癌5例，直肠间质瘤1例，直肠腺瘤9例，增生性息肉2例。所有患者手术过程均顺利，无肛门失禁病例。3例并发粪瘘（3／31，9．6％），其中2例予术后1个月痊愈，1例术后2周再次行横结肠袢式双腔造瘘术。2例直肠腺瘤患者术后1年出现复发（2／31，6．5％）．1例追加Parks术，1例再次经肛局部扩大切除。14例直肠腺癌，T1期9例，T2期5例，无局部复发．总的5年生存率为90％。5例直肠类癌的5年生存率为100％。1例间质瘤目前生存3年。结论改良的经骶尾后入路Kraske术为直肠中下段的各种良性和选择性的恶性肿瘤的保肛手术提供了1个安全、有效、易操作和患者易耐受的手术方式。

Objective To evatuate the application and indication of modified Kraske posterior approach in the excision and anus-preserving treatment of benign and malignant tumors of mid-lower rectum. Methods The clinical records of 31 patients of midlower rectal tumor were analyzed retrospectively, who were hospitalized and received this procedure during the period between November 1997 and November 2005. Results Of the 31 patients,there were 14 cases of rectal adenocarcinoma,5 of rectal carcinoid tumor, 1 of rectal gastrointestinal stromal tumor, 9 of rectal carcinoma,and 2 of proliferative polyps. No complication occurred during the operation. There was no operative mortality and no postoperative incontinence. Fecal fistula occurred in 3 patients （3/31,9.6 % ）. Of them,two developed a healing of the fistula one month after the surgery; the other was treated by a transverse colostomy two weeks after the procedure. Local recurrence occurred in two patients of rectal adenoma after an interval of one year （2/31,6.5 % ）. Of them,one was treated by Parks procedure,another by transanal excision. Of the 14 rectal carcinoma patients, 9 were. T1 stage and 5 were T2, the overall survival at 5 year is 90 %. The 5-year survival rate of the 5 cases of carcinoid is 100 %. 1 case of the GIST patient has survived for 3 year. Conclusion This modification of the Kraske transsacral poaterior approach offers a good alternative of excision and anus preservation for the benign and selective malignant tumors of the mid-lower rectum in terms of technical ease,efficacy, safety ,and patient tolerance.