低位直肠癌保肛手术临床观察(附48例报告)

Analysis of 48 cases of anal sphincter preserving operation for low rectal carcinoma

目的探讨低位直肠癌保肛手术的治疗效果。方法对48例低位直肠癌(肿瘤下界距肛缘4～7cm)患者采用双吻合器行保肛手术治疗(保肛组),其中2例为多发癌,6例合并肠梗阻,对前期60例直肠癌行Miles术(Miles组),比较2组患者术后3年生存率、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8.33%和8.33%,3年生存率分别为87.5%和88.3%,2组比较差异无显著性(P>0.05);1年后2组患者大便次数均明显减少,差异无显著性(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4～7cm之间的低位直肠癌,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。多发癌或并发结肠梗阻、不是保肛手术禁忌症。

[Objective] To explore the curative effects of anal sphincter preserving operation for low rectal carcinoma. [Methods] 48 cases of low rectal carcinoma between 4～7 cm from anal verge were underwent anal sphincter preserving operation using double stap Hng device （ASPO group）, 2 of them were multiple synchronous cancer and 6 patients have acute colon obstruction. 60 cases of rectal carcinoma between 2～7 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 8.33% and 8.33% respectively, the three-year survival rate of the two groups was 87.5% and 88.3% respectively, and there was no significant difference between the two groups （P 〉0.05）. Defecation frequency of the two groups were 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 4～7 cm from anal verge can be done on patients. 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. Multiple synchronous cancer and colon obstruction are not the surgical contraindication.