78例低位直肠癌保肛术的临床疗效分析

Clinical effect of sphincter-preserving surgery on 78 cases with low rectal cancer

目的探讨低位直肠癌保肛术的安全性和对肿瘤的根治性。方法回顾性分析2003年1月至2008年6月于我科应用吻合器行根治性保肛手术的78例低位直肠癌患者的临床资料,手术遵循直肠癌根治切除术和直肠系膜全切除术的原则,远近切缘距肛瘤分别至少达2.5cm及10cm,应用双吻合器法于骶前行结直肠端端吻合。结果 78例患者均一期行吻合,无手术死亡。术后56例患者出现肛门刺激症状,予对症治疗8～12个月,症状均有明显改善。2例患者出现吻合口瘘,分别予保守及手术治疗后治愈。2例患者出现排尿功能障碍,2例患者出现性功能障碍,予对症治疗后均有缓解,各有1例患者出现脂肪液化及伤口感染,予加强伤口换药护理后愈合。吻合口狭窄1例,于门诊定期扩肛后缓解。所有患者术后均行folfox4方案辅助化疗,术后成功随访72例患者,吻合口复发1例,盆腔复发3例,其中并发肺转移1例,复发转移率为5.56。结论应用双吻合器法进行低位直肠癌的保肛手术是安全有效的,同时可保证肿瘤的根治性和较好的保留患者的排便、排尿及性功能。

Objective To investigate the clinical effect of sphincter-preserving surgery on 78 cases with low rectal cancer.Methods Clinical data of 78 patients with low rectal cancer from Jan 2003 to Jun 2008 were analyzed retrospectively.Radical resection of rectal cancer and TME principle were followed,at least 2.5 cm and 10 cm away from the distant margin and near margin.Double stapling technique was used to make colorectal anastomosis.Results All 78 cases of patients received one-stage anastomosis and there was no dead case.56 cases with defecation disorder postoperatively recovered after 8~12 months＇ treatment.2 cases with anastomotic leakage recovered after conservative treatment or surgery.2 cases with dysuria and 2 cases with sexual dysfunction recovered after conservative treatment.1 case with wound infection and 1 case with fat liquement recovered after dressing change.1 case with anastomotic stenosis recover after anal dilatation regularly.All patients accepted chemotherapy postoperatively and 72 cases of them accepted follow-up,which showed the result of 1 case with stoma recurrence,3 cases with pelvic recurrence and 1 case with lung metastasis.The relapse and metastasis rate was 556%.Conclusion Sphincter-preserving surgery on low rectal cancer using double stapling technique is safe and redical,without damaging the function of defecation,urination and sexual.