中低位直肠癌行套入式吻合保肛术371例临床经验

Clinical experience of 371 cases of sphincter-preservation with telescopic anastomosis after radical excision for low-middle rectal cancer

目的探讨套入式吻合保肛术式治疗中低位直肠癌的安全性和临床疗效。方法对371例中低位直肠癌根治性切除行套入式结肠直肠黏膜吻合保肛术患者的临床资料进行总结分析。结果371例患者男224例、女147例。年龄21～99（平均57．9）岁。肿瘤下缘距肛缘5-8cm；病理诊断直肠腺癌361例．其巾高分化138例，中分化201例．低分化者11例，黏液腺癌11例，腺瘤癌变10例。TNM分期：Ⅰ期120例，Ⅱ期222例．Ⅲ期26例，Ⅳ期3例。术后12～24周时排便功能基本恢复到正常。术后随访率85．7％（318／371），中位随访时间为5．8年。术后发生吻合口瘘16例（4．3％）．吻合口狭窄8例（2．1％）：局部复发率为6．3％（20／318），术后总体5年生存率为69．7％。结论套入式结肠直肠黏膜吻合保肛术式治疗中低位直肠癌．术后能使患者保留良好的肛门控便功能．是安全有效的直肠癌保肛术式之一。

Objective To evaluate the elinical efficacy, feasibility and safety of sphincterpreservation with telescopic anastomosis of colon and rectal mucosa in low-middle rectal cancer. Methods A retrospective analysis was carried out in 371 patients with low-middle rectal cancer in whom telescopic anastomosis was used. There were 224 males and 147 females, with a mean age of 57.9 （21-99） years. The lower margins of the tumors located between 5-8 cm from the anal verge. On histopathology, there were 361 adenocarcinomas, including 138 well-differentiated, 201 moderately differentiated, 11 poorly differentiated, 11 mutinous adenocarcinoma, and 10 adenomas with neoplastic changes. According to the Duke＇s stage classification, 120 were TNM stage Ⅰ , 222 stage Ⅱ , 26 stage Ⅲ, and 3 stage Ⅳ. Results Three hundred and eighteen （318/371, 85.7%） eases were followed up, and the median follow up time was 5.8 years. Postoperative complications were observed, including 16 （4.3%） cases with anastomotic leak, and 8 （2.1%） with anastomotic stenosis. All the patients resumed normal bowel function during 12-24 weeks after operation, with 1-3 times per day. The local reeurrence rate was 6.3%（20/318）. Hepatic and lung metastasis was 14.5%（46/318） and 2.5%（8/ 318）, respectively. The 5-year survival rate was 69.7%. Conclusion The sphincter-preservation with telescopic anastomosis procedure is safe and effective for low-middle rectal cancer, and the sphineter function can be well-preserved.