直肠癌根治术381例疗效分析

Analysis of 381 cases of radical resection of rectal carcinoma

目的 探讨Miles手术和保肛手术治疗直肠癌的临床疗效。方法 选择1995-01／2005—1210年间收治直肠癌病人381例，直肠癌病人分别行Miles手术和保肛手术，其中行Miles手术128例，各种保肛手术253例。同时结合化疗，DukesC期、D期病人予放疗。结果 术后共有321例病人进行随访，时间为3个月～10年，平均5．6年，随访率84．3％。术后局部复发率为5．0％（16／321）。其中Miles手术为4．8％（5/105），保肛手术为5．1％（11/216），其中一期肛门原位再造术为4．6％（3／65）。5年生存率为69.8％（224/321），其中Miles为67．696（71／105），保肛手术为70．8％（153/216），其中一期肛门原位再造术为72．3％（47／65）。结论 直肠癌术式选择应科学、合理、正确，低位直肠癌经腹、会阴切除，一期肛门原位再造术是一种合理、有效的术式。

AIM To investigate and analysis curative effects of Miles operation and anal sphincter operation for rectal carcinoma in 10 years. METHODS 381 cases of rectal carcinoma were analysed retrospectively, who underwent radical resection including 128 cases of Miles operation and 253 cases of anal sphincter preserving procedures, all patients received chemotherapy, part cases received radiotherapy who were in stage C or stage D of Dukes. RFSULTS Among the 321 of 381 cases （84.3%）were followed up. local recurrence rate of post operation was 5.0 % （16/321）, 4.8 % for Miles operation, 5.1% for anal sphincter preserving procedures with the procedure of transabdominal perineum and primary of Anus in situ. The local recurrence rate was 4.6 %. the five - year sur- vival rate was 69.8% （224/321）in all cases, for Miles operation 6？. 6% （71/105） ,for anal sphincter preserving procedures ？0.8% （153/216）with the procedure of transabdominal perineum and primary anoplasty in situ. The five- year survival rate was ？2.3 % （4？/ 65）.CONCLUSIONS the choice of the operation for rectal cancer should be scientific, reasonable and right. The procedure of transabdorninal perineum and primary reconstruction of anus in situ is a reaasonable effective surgical procedure in the treatment of lower rectal carcinoma.