低位直肠癌保留肛门手术的评价

The assessment of sphincter saving resection(SSR)for the treatment of low rectal carcinoma

目的评价保留肛门(下称保肛)手术在切除低位直肠癌手术中的地位。方法回颐性分析我院1954年1月至1996年12月手术治疗直肠癌2074例,其中低位直肠癌1594例,占76.86%。低位直肠癌中能行切除手术者1304例,切除率81.81%,其中441例为保肛手术(sphincter saving resection,SSR),占33.82%(441/1304),比较80年代前(Ⅰ组),80年代(Ⅱ组)和90年代(Ⅲ组)3组保肛手术的情况。结果 SSR Ⅰ组16.05%(82/511),Ⅱ组40.76%(161/395),Ⅲ组49.75%(198/398)。SSR 中 Dixon 术Ⅰ组占39.02%(32/82),Ⅱ组62.73%(101/161),Ⅲ组70.71%(140/198)。SSR 的总手术病死率0.45%(2/441)。Dixon 术总的吻合口漏发生率为8.06%(22/273),Ⅲ组中61例属超低位吻合术,术后吻合口漏的发生率为6.58%(4/61),腹会阴切除术(abdominal-perineal,AP)后局部复发率为12.46%(70/562).SSR 为13.15%(58/441)此两组比较差异无显著意义(P>0.05),Ⅰ组为12.20%(10/82),Ⅱ组为13.66%(22/161),Ⅲ组为12.63%(25/198)各组间比较,差异均无显著意义(P>0.05)。术后5年生存率Ⅰ组(63±5)%,Ⅱ组(70±4)%,Ⅲ组(82±4)%,各组间比较疗效有显著提高(P<0.05)。。结论低位直肠癌选择做 SSR 并不影响疗效,加强综合治疗是促使本组 SSR 比例不断提高,且5年生存率也相应提高的主要原因。

Objective This paper is to elucidate the role of SSR in low rectal carcinoma.Methods 2074 cases of rectal carcinoma were treated surgically between January 1954 through December 1996,among which 1594 le- sions situated below the peritoneal reflection accounting for 76.86% of the total cases.Tumors in 1 304 out of 1 594 cases were resectable,with a resectability rate of 81.81% in low rectal carcinoma and SSR was carried out in 441 cases (33.82%).Results The SSR ratio was 16.05% in Group Ⅰ (before the year of 80s'),40.76% in Group Ⅱ(during the period of 80s')and 49.75% in Group Ⅲ(in 90s').Dixon's operation was the prefer- able procedure in SSR and accounted for 39.02% in Group Ⅰ,62.73% in Group Ⅱ and 70.71% in Group Ⅲ.The overall operative mortality rate in SSR was 0.45%.The incidence of anastomotic leakage following Dixon's operation was 8.06% and 61 cases in Group Ⅲ underwent ultra-low anastomosis with an anastomotic leakage rate of 6.58% (4/61).The local recurrence rate following Mile's procedure was 12.46%,and 13.15% in all cases following SSR,with the rate of 12.20% in Group Ⅰ,13.66% in Group Ⅱ and 12.63% in Group Ⅲ,respectively(P>0.05).The 5 year survival rate in Group Ⅰ was (63±5)%,(70±4)% in Group Ⅱ and (82±4)% in Group Ⅲ (P<0.05).Conclusions Selective SSR in low rectal carcinoma has a comparable good long term results as Mile's procedure.Perioperative intensive and comprehensive therapy un- derlay the improvement of long-term results in recent years.