两种拖出式超低位直肠癌保肛术疗效分析

Comparison of Two Pull-out Resection Sphincter-reserving Operations for Ultra Low Rectal Cancer

目的探讨双吻合器法与免吻合器法两种拖出式超低位直肠癌保肛术的优缺点。方法 我院2004年8月—2009年8月行拖出式超低位直肠癌保肛术患者52例,随机分为双吻合器组和免吻合器组,对比分析两组患者术后并发症、术后肛门功能恢复情况、复发转移情况及住院费用。结果两组患者各有1例吻合口狭窄,经扩肛治疗后缓解,均无吻合口漏并发症发生。无吻合器组术后3个月肛门功能恢复优良患者较双吻合器组明显增多,差异有统计学意义(P<0.05)。术后随访1～6年,两组患者均无肿瘤局部复发及远处转移。无吻合器组住院费用较双吻合器组明显降低,差异有统计学意义(P<0.05)。结论免吻合器较双吻合器拖出式超低位直肠癌保肛术更简单易行、安全可靠、经济实用,在严格掌握适应证的前提下,作为超低位直肠癌的一种保肛术式选则,更值得推广。

Objective To evaluate the advantages and disadvantages of two pull-out resection sphincter-preserved operations for low anterior rectal cancer. Methods Totally 52 patients who were treated in our hospital between August 2004 and August 2009 were equally randomly divided into double stapling technique group and without stapling technique group,and their clinical data were analyzed. Results All patients underwent operation successfully.One anastomotic stenosis was noted in each group,which was relieved after the expansion anus treatment.No anastomotic leak occurred in both groups.The anal functions of all patients were good one year after operation.No local recurrence and distant metastasis occurred in all patients during the 1-6-year follow-up.The cost during hospital stay was significantly lower in double stapling technique group than in without stapling technique group（P〈0.05）. Conclusion Pull-out resection sphincter-preserved operation for low anterior rectal cancer without stapling technique is safer,cheaper,and more feasible than double stapling technique.Pull-out resection sphincter-preserved operation for low anterior rectal cancer is therefore recommended under the strict indication.