保肛术与腹会阴联合切除术治疗超低位直肠癌疗效分析

Therapeutic Comparison and Analysis of Anus-preservation Procedure and Mile＇s Procedure in the Treatment of Ultra Low Rectal Carcinoma

通过保肛术与腹会阴联合切除术治疗超低位直肠癌疗效分析，探讨超低位直肠癌保肛手术的适应症、术式选择及疗效。回顾分析获随访超低位直肠癌根治手术患者94例，其中保肛术48例。腹会阴联合切除术（APR）46例。一般资料分布情况无明显差异，比较二者术后并发症、复发率和生存率，并行保肛功能评定。结果显示，保肛率51．1％，其中低位前切除术（LAR）39例，含腹腔镜下LAR术6例，腹腔镜下Parks术5例，保留直肠肌鞘的改良结肠肛管吻合术4例。术后吻合口漏2例，狭窄3例，异时肝转移2例；2年内复发6例。APR组腹腔内腹腔镜下操作12例。术后会阴部感染5例，骶前出血2例，造口旁疝2例，异时肝转移3例；2年内复发7例。Log-Rank test分析两组生存率无显著性差异。保肛术组术后1年内评价排便功能，优良率占91．7％。结果表明，在根治切除前提下，超低位保肛术能提高生活质量，而不增加术后并发症和复发率，生存率也不比腹会阴联合切除术低，低前切除吻合术具有较好的排便功能。

Therapeutic efficacy of anus-preservation procedure and Mile＇s procedure in the treatment of ultra low rectal carcinoma was compared and analized, and indication, options of procedures ＆ therapeutic effect were discussed. Ninety four cases with ultra low rectal carcinoma, who underwent radical surgery were analized retrospectively,of which 48 cases underwent anus-preservation procedure （group A） and 46 Mile＇s procedure（group B）. As results,in group A,low anterior resection （LAR）was applied in 39 cases in- cluding laparoscopic LAR in 6 cases,laparoscopic Parks operation in 5 cases,and modified coloanal anastomosis （with rectal muscle sheath preserved ） in 4 cases;postoperative anastomotic leakage occurred in 2 cases,stricture in 3 cases,heterochronic hepatic metastasis in 2 cases,and recurrence with in 2 years in 6 cases;the anus-preservation rate was 51. 1%0. While in group B,via laparoscopic resection in abdomen was done in 12 cases;postoperative perineal infection occurred in 5 cases, presacral bleeding in 2 cases,peristomal hernia in 2 cases,heterochronic hepatic metastasis in 3 cases, and recurrence within 2 years in 7 cases. Results of Log-Rank test analysis showed no notable statistical significance. Evaluation of defecation function one year after operation in group A revealed that the excellent and improved rates were altogether 91.7%. It is suggested that on the basis of radical resection,anus-preservation procedure in the treatment of ultra low rectal carcinoma can raise life quality while postoperative complications and recurrence are not increased,and the survival rate is not low against that in group B（Mile＇s operation）;and that low anterior resection and anastomosis can ensure better defecation function.