部分齿线区切除在超低位直肠癌根治保肛术中的应用

THE APPLICATION OF LINEA PARTS RESECTION DURING RADICAL OPERATION OF ULTRALOW RECTAL CANCER

目的:探讨部分齿线区切除在超低位直肠癌根治保肛术中的应用效果。方法:2001至2003年对11例肿瘤下缘距齿线<3cm的超低位直肠癌,采用保证全系膜直肠切除及盆腔淋巴结清扫,部分齿线区切除,结肠贮袋经肛拖出与肛管直肠齿状线吻合的方法,术中冰冻切片证实切缘无癌残留。术后10例完成化疗,8例接受放疗。结果:本组无死亡病例,随访2月至1年,平均6.4个月,患者均无严重手术并发症,肿瘤无复发和转移。按WCGWP肛门功能调查表检查患者术后肛门功能情况,2例便频,1例稀便失禁,1月后均恢复,无梗阻发生。结论:在超低位直肠癌根治保肛术中,采用保证全系膜直肠切除及盆腔淋巴结清扫,部分齿线区切除,结肠贮袋经肛拖出与肛管直肠齿状线吻合的方法,可以达到直肠癌根治和超低位保肛的目的。

Objective：To investigate the effects of linea parts resection during radical operation of uhralow rectal cancer and preserving anus.Methods：Eleven cases,of which the distance from linea dentate is less than 3 cm,underwent radical operation of rectal cancer from 2001 to 2003 .Their anus were preserved.Total mesorectal rectal was excised completely and lymph node in pelvis cavity were removed.Anus and colon pouch pulled through anus were connected by anastomosis.No remnant of the cancer was confirmed by frozen-slice during surgery.Ten cases finished chemotherapy and eight cases received radiotherapy after surgery.Results：There was no death in the group from two months to one year （mean 6.4 months）following up after surgery,there was no serious complication,no recurrence and no metastasis.To examine the function of anus according to the WCGWP,the frequency of defecation was high in two cases,the tenuous stool could not be controlled in one case ,but both of them recovered after one month.Obstruction has not happened.Conclusion：Linea parts resection with anus pulled up to perform coloanal anastomosis during radical operation of uhralow cancer and preserving anus that total mesorectal rectal excised and lymph node in pelvis were removed completely,are essential radical operation of ultralow rectal cancer and preserved anus. ,making sure to achieve a radical operation of ultralow rectal cancer and preserved anus.