低位直肠癌保肛术式的选择

Sphincter-preserving surgery in patients with lower rectal cancer

目的对低位直肠癌保肛术式的选择方法进行探讨。方法2003年1月至2008年1月期间，对137例低位直肠癌按无瘤原则行保肛术，术中将血供良好的结肠断端无张力拉下吻合，恢复肠道肛管的连续性。结果行双吻台器低位前切除术102例中，91例直肠癌基底距肛缘6～8cm，11例直肠癌基底距肛缘5～6cm，后者肿瘤均位于直肠后壁；行Parks术或改良Bacon术35例中，直肠癌基底距肛缘均为5～6Cn]。Parks术19例均为乙状结肠与肛管吻合；改良Bacon术16例均行降结肠经肛管拖出手术：结论对肿瘤基底距肛缘6～8cm和少数较瘦患者、基底距肛缘5～6cm、且肿块位于直肠后壁的低位直肠癌可以采用双吻合器低位前切除术：对肿瘤基底距肛缘5～6cm的低位直肠癌，可以行Parks术或改良Bacon术，其中乙状结肠较长时可以行乙状结肠与肛管吻合的Parks术；乙状结肠长度不够时可以游离结肠脾曲或左半结肠，行降结肠经肛管拉出的改良Bacon术。

Objective To evaluate different operative modalities for sphincter-preserving procedures in patients of lower rectal cancer. Methods A total of 137 patients with lower rectal cancer underwent sphineter-perserving surgery between January 2003 and January 2008. In the operation, the proximal colon with satisfactory blood supply was pulled down to reestablish intestinal continuity without any tension. Results Among the 137 patients, 102 patients underwent low anterior resection by double stapling technique, 16 patients were dealed with the Parks operation, 19 patients were dealed with the modified Bacon operation. In the double-stapling technique group , the distance between the anal verge and inferior margin of the tumor was 6 -8 cm in 91 patients and 5 -6 cm in 11 patients whose tumors were located at posterior rectal wall. In the other two groups, the distance between the anal verge and inferior margin of the tumor was 5 - 6 cm. In the Parks operation, the sigmoid colon was anastomosed with the anus in all of 19 patients. In the modified Bacon operation group, the descending colon was pulled through anus in all of 16 patients. Conclusions The low anterior resection with double stapling technique can be applied to a patient if the distance from the inferior margin of the tumor to the anal verge is 6 cm to 8 cm. The Parks operation or the modified Bacon operation can be applied to a patient if the the distance from the inferior margin of the tumor to the anal verge is 5 to 6 cm, The Parks operation can be performed with the sigmoid colon being anastomosed with the anus if the length of the sigmoid colon is long enough to reach the anus, the modified Bacon operation can be performed with the descending colon being pulled through the anus by mobilization of splenic flexure or left colon if the length of the sigmoid is not long enough to reach the anus.