低位直肠癌的保肛手术(附58例分析)

Anus preservation operation of low position rectal carcinoma: an analysis of 58 cases

目的探讨如何选择适合保肛的方法治疗低位直肠癌。方法58例肿块下缘距肛缘4～7cm的低位直肠癌患者,对27例采用保留肛管括约肌术式(A组)、31例采用吻合器技术Dixon前切除术进行治疗(B组);并对两组疗效进行对比。结果A组患者无远端直肠残端肿瘤残留,B组有2例。肿瘤远端切除距离,A组平均为3.12cm,B组1.84cm,两组比较,差异有显著性(P<0.05)。A组术后2年无局部复发,B组有5例局部复发,B组局部复发明显高于A组(P<0.05)。A组5年生存率74.6%,B组65.1%,两组比较差异无显著性(P>0.05)。A组术后早期排便功能较差,但均能在半年内改善;B组排便功能较好。结论低位直肠癌患者肿瘤下缘距肛缘4～7cm、肿瘤Dukes分期B、C期、术前指诊肿瘤可推动、肿瘤侵犯肠壁不到1周者可行保肛手术。应根据患者体形、骨盆宽窄、肿瘤分化程度、肿瘤侵犯肠管的周径来选择保留肛管括约肌或吻合器技术Dixon前切除术。保留肛管括约肌术式可作为Dixon术最佳备选手术。

[Objective] To discuss how to select the appropriate anus preservation way to treat low position rectal cancer. [Methods] 58 patients had low position rectal cancer with the tumor inferior border from 4 to 7 cm apart from the anus border. Anal sphincter preservation operation was performed for 27 cases （group A） and rectal anteri- or resection low position anastomosis Dixon for 31 cases （group B）, their curative effects were compared. [Results] Patients of group A didn＇t have any residual distal rectal stump tumor, while two patients of group B did have. Comparing the tumor distal resection distance, the average distance of group A was 3.12 cm, and group B was 1.84 cm. This difference had significance（P 〈0.05）. Two years after the operation, the patients of group A had local relapse, but there are five cases of group B did have. The rate of local relapse of group B was obviously higher than group A （P 〈0.05）. Comparing the 5-year survival rate, group A was 74.6%, and group B was 65.1%, there is no statistical significance （P 〉0.05 ）. After the operation the early defecation of group A is not good, but it was gradually improved in half a year, group B was better. [Conclusion] For the patients with low position rectal carcinoma that the tumor inferior is from 4 to 7 cm apart from the anus border, tumor is in Dukes B, C, the tumor can be pushed by finger examination before operation and the tumor invasion to intestinal wall is not more than one loop, anus preservation operation can be performed. Anal sphincter preservation operation or rectal anterior resection low position anastomosis Dixon should be chosen according to the patient＇s somatotype, the width of pelvis, tumor differentiation degree, the girth that the tumor invades the intestinal trait. Anal sphincter preservation operation can be regarded as the best preserved operation of anastomosis Dixon.