从术后局部复发形式探讨低位直肠癌保肛手术的适应证

From exploring the form of postoperative local recurrence of low rectal cancer indications for sphincter-saving surgery

为合理实施直肠癌保肛手术、减少局部复发、提高存活率及生存质量,从中低位直肠癌术后局部复发形式探讨保肛手术的适应证。(1)如何延长病人的生存期是第一重要的原则,而生存质量应属第二位。(2)局部复发的主要形式是由于肿瘤下切端不足、淋巴清扫范围不足及没有按照TME原则进行手术有关。(3)应该在避免以上问题的前提下合理实施保肛手术。其中,肿瘤下缘距离肛门至少5cm以上是最重要的一点,否则无原则的保肛手术不仅不能提高病人的生存质量,而且还能影响生存期限。

To properly perform sphincter-preserved surgery, decrease local recurrence and improve survival rate and quality, some opinions are proposed to explore the indications of sphincter-preserved surgery, which are based on the patterns of local recurrence following middle-low rectal cancer resection： （1）The most important principle is how to prolong survival time rather than survival quality. （2） The main reasons for local recurrence include insufficient rectal margin, inadequate lymphadeneetomy and atypia TME. （3） Sphincter-preserved surgery should be performed avoiding the above problems. The 5cm length between the rectal margin and anus is the key point, otherwise which will not only impair survival quality but also shortage survival time.