低位直肠癌括约肌间切除超低位吻合的疗效评估

Efficacy evaluation of intersphincteric resection during anus-preserving operation for ultralow rectal carcinoma

目的评价超低位直肠癌行括约肌间切除手术（ISR）后的舡肠动力学变化、肛门功能及肿瘤根治效果。方法总结分析2004年1月至2007年8月间施行ISR手术的30例超低位直肠癌患者的临床资料。结果30例患者肿瘤距肛缘2．5～4．0（平均3．4）cm。与术前比较．术后肛管静息压、肛门最大收缩压和直肠最大耐受容积明显降低（P〈0．01）．有27例（90．0％）患者术后肛门直肠抑制反射消失，且随着时间推移无明显恢复。按Williams的排便自制标准．术后3、6、12个月分别有86．7％、93．3％和96．7％的患者达到功能良好效果。全组患者随访1年至3年8个月．无死亡病例；未出现盆腔或吻合口局部复发、远处转移和吻合口瘘。10例术后出现肛周粪渍性湿疹，2例结肠黏膜脱出，1例肛管狭窄。结论ISR超低位吻合保肛手术治疗低位直肠癌可以达到良好的根治性．并能较好地保留肛门功能。

Objective To evaluate anorectal dynamics, function and efficacy of uhralow rectal carcinoma patients undergone intersphincteric resection （ISR）. Methods From January 2004 to August 2007, 30 patients with ultralow rectal carcinoma （2.5-4.0 cm distance from anal edge） underwent ISR. All the patients received anorectal manometry before and after operation. The postoperative anal function was evaluated by Williams continence standard and the treatment outcome was followed up. Results After ISR operation, anal resting pressure, maximum squeeze pressure and maximum tolerance volume of the rectum decreased significantly （all P〈0.01） and restored gradually, but not to normal. The rectal anal inhibitory reflex disappeared in 27 patients （90.0%） and was not improved. According to Williams continence standard, 86.7%, 93.3% and 96.7% of patients obtained acceptable anal function in 3, 6, and 12 months after operation respectively. During follow-up of 12 to 44 months, all the patients were still alive and no patient developed pelvis or local recurrence, distant metastasis and anastomotic leakage. Fecal eczema of anus occurred in 10 patients, colonic mucosa prolapse in 2 patients and stenosis of anal canal in one patient. Conclusion ISR for uhralow rectal carcinoma can not only attain radical treatment outcome, but also preserve anal sphincter.