超低位直肠癌保肛术68例分析

Analysis of 82 cases of anal sphincter preserving operation for ultra-low rectal carcinoma

目的探讨超低位直肠癌保肛手术的治疗效果。方法对68例超低位直肠癌(肿瘤下界距肛缘3.5～5cm)患者采用双吻合器行保肛手术治疗(保肛组),对同期52例超低位直肠癌行Miles术(Miles组),比较2组患者术后3 a生存率、局部复发率、排便功能和控便能力。结果保肛组和Miles组术后局部复发率分别为8.8%、7.8%,3 a生存率分别为89.7%、88.5%,2组比较无显著差异(P>0.05);1 a后2组患者大便次数均明显减少,差别无显著性(P>0.05);Miles组术后丧失控便能力,而保肛组的控便能力逐渐好转,12个月时已无患者存在大便失禁,明显优于Miles组(P<0.05)。结论对于距肛缘3.5～5 cm之间的超低位直肠高中分化腺癌,处于Dukes A、B期以及侵犯肠周未超过1/2者,行保肛术是合理可行的,可获得与Miles术相似的近期疗效,且具有更好控便能力。

Objective To explore the curative effects of anal sphincter preserving operation for ultra-low rectal carcinoma. Methods 68 cases of ultra-low rectal carcinoma between 3.5 ～5 cm from anal verge were underwent anal sphincter preserving operation using double stapling device（ ASPO group） ,and 52 cases of ultra-low rectal carcinoma between 3.5 ～ 5 cm from anal verge were underwent Miles operation （Miles group）. Analysis was conducted on three-year survival rate,local recurrence rate, defecation function and fecal control function between the two groups. Results The local recurrence rate of ASPO group and Miles group was 8.8% and 7.8% respectively,the three-year survival rate of the two groups was 89.7% and 88.5% respectively, and there was no significant difference between the two groups （ P 〉 0. 05）. Defecation frequency of the two groups was reduced after one year, and no statistical difference（P 〉 0. 05）. The fecal control function for ASPO group improved obviously after 12 months, and no complete fecal incontinence occur. But Miles group has not fecal control function. ASPO group provides better postoperative fecal control function than Miles group（ P 〈 0.05）. Conclusion Anal sphincter preserving operation for rectal cancer between 3.5～ 5 cm from anal verge can be done on patients as follow：high and middle differentiation adenocarcinoma,less than 1/2 circle of rectum,Dukes A or B stage. Anal preservative operation provides the same curative effect as Miles operation does in a short term follow-up, and it can achieve better postoperative function than Miles operation in fecal control function.