经肛门拖出低位切除术治疗直肠癌的临床研究

Clinical research of low resection of rectal carcinoma in pull-through anus operation

目的探讨直肠癌经肛门拖出低位切除术的临床价值及癌肿沿肠壁远端转移的影响因素。方法前瞻性分析43例经肛门拖出低位切除术治疗的直肠癌患者的临床、病理及随访资料，并对数据进行统计学处理。结果成功施行经肛门拖出低位切除术41例（95．3％），无一例并发吻合口漏，3例术后局部复发。高、中分化与低分化直肠癌距远端阴性切缘的平均长度差异有统计学意义，但高、中分化间差异无统计学意义，不同Dukes分期距阴性切缘的平均长度差异均有统计学意义。结论高、中、低分化和DukesA、B、C期的远端直肠癌肠管合理切除长度应分别不少于2．0、3．0、4．0cm，经肛门拖出低位切除术可以作为常规的直肠癌根治性切除术式。

Objective To explore the value of low resection of rectal carcinoma in pull-through anus operation and its influence factor with rectal carcinoma distant metastases along intestine wall. Method Clinical pathological and visited data of 43 patients with rectal carcinoma were analyzed prospectively. Resuits Forty-one cases were successfully accepted resection in pull-through anus （95.3%）. No patient suffered from stoma leak, 3 cases appeared recurrence after operation. Compared between high differentiation patients and mid differentiation patients, there was no significant difference, while the difference of comparing between high or mid differentiation patients and low differentiation patients respectively, there was sig- nificant difference. The difference of comparison among Dukes stage A, B or C was significant. Conclusions The right length of incising distant intestine tube is more than 2.0, 3.0, 4.0 cm respectively for rectal careinoma of high, mid and low differentiation or that of Dukes stage A, B or C. Low resection of rectal carcinoma in pull-through anus should be considered as a regular operation.