经腹及肛门内括约肌切除保肛术治疗低位直肠癌的临床研究

Anus-preservlng procedure with the resection of interred sphincter muscles for the treatment of ultra-low rectal cancer

目的 探讨经腹及肛门切除肛门内括约肌的直肠癌根治保肛术治疗低位直肠癌的临床疗效。方法 对34例癌灶下缘距齿状线不足2cm或距肛缘不足4—5cm的低位直肠癌经腹及肛门切除肛门内括约肌保肛术进行回顾性分析。结果 34例中男23例，女11例。年龄28—76岁，平均为56．4岁。癌灶下缘距肛缘4cm12例（腺瘤癌变5例），癌灶下缘距肛缘5cm22例，病理诊断直肠腺癌29例，其中高分化者18例，中分化者11例，腺瘤癌变5例。Dukes分期：A期18例，B期16例。34例术后随访率为97％（33／34），中位随访时间为4．9年。术后发生吻合口瘘1例（2．9％），吻合口狭窄1例（2．9％）；术后6—12个月时排便功能基本恢复正常。术后局部复发率为2.9％，术后5年生存率为69．6％。结论 经腹及肛门切除肛门内括约肌的直肠癌根治保肛术式，既能保存良好的肛门排便功能，又不降低5年生存率，是一种安全有效的低位直肠癌保肛术式。

Objective To evaluate anus-preserving procedure with the resection of internal sphincter muscles for the treatment of uhra-low rectal cancer through a combination per anum-abdominal approach. Methods In this study, 34 cases of uhra-low rectal cancer with the inferior border of the cancer 2 cm to anocutaneous line or 5 cm to the verge of anus underwent anus-preserving procedure with the resection of internal sphincter muscles transabdominally and per anum. There were 23 males, 11 females, age from 28 to 76 years. Inferior border of the cancer was 4 cm to the verge of anus in 12 cases, and 5 cm in 22 cases. Postoperative pathologic diagnosis included adencareinoma in 29 cases, and adenoma cancerization in 5 cases. Dukes A stage in 18 cases, and B stage in 16 cases. Results The follow-up rate was 97. 0% （33/34）, and the median follow-up period was 4. 9 years. Pestoperatively 1 case developed stoma leak （2. 9% ）, and 1 developed stoma stenosis（2.9% ）. The anus defecation control recovered in 6 ~ 12 mouths after operation. The local recurrence rate was 2. 9%, and the 5-year-survival rate was 69.6%. Conclusion By anus-preserving procedure with the resection of internal sphincter muscles, defecation control was well reserved by anus, and not at the cost of the 5-year-survival rate.