经括约肌间切除术治疗超低位直肠/肛管癌的疗效分析

The quality of the intersphincteric resection for ultra-low rectal cancer and anal cancer

目的 探讨经括约肌间切除术治疗超低位直肠/肛管癌的疗效.方法 2010年1月～2011年12月期间,在四川大学华西医院胃肠外科中心结直肠外科专业组接受经括约肌间切除术并符合本研究条件的超低位直肠/肛管癌患者共205例.结果 205例均顺利完成手术,肿瘤距肛距离0～5cm,平均（2.37±1.91）cm.排气时间1～11d,平均（3.93±1.24）d;排便时间1～17d,平均（5.20±1.86）d;下床活动时间1～7d,平均（2.22±1.53）d;住院时间7～114d,平均（16.18±10.26）d.术后发生吻合口瘘8例（3.9%）;切口感染2例（1.0%）,肛周感染15例（7.3%）.205例患者均获随访,平均随访24个月,随访结果中出现复发的患者共9例（3.4%）.随访获得的死亡患者总数为11例,死亡率为5.4%.吻合口狭窄3例（1.4%）.结论 ISR治疗超低位直肠/肛管癌患者能够取得良好的近远期疗效,具有良好的保肛和根治效果,是安全可行的.且对于距肛距离≤2cm的直肠癌患者,只要癌肿未侵及外括约肌,ISR仍是有效保肛治疗手段.

Objective To explore the quality of the inersphincteric resection for uhral-low rectal cancer and anal cancer. Methods Retrospectively identified patients received inersphincteric resection from January 2010 to December 2011 who were diagnosed as rectal/anal cancer by colorectal surgical team of West China Hospital in Sichuan University. Results 205 patients were successfully performed the operation,the lower edge of tumor from the anus edge was 0 - 5em （ average 2.37± 1.91cm）, first aerofluxus time was 1 - 11 d （average 3.93± 1.24 d）, first defecation time was 1 - 17d （average 5.20± 1.86 d）, first ambu- lation time is 1-7d （average 2.22± 1.53 d）, The hospital stay is 7 -114d（ average 16.18±10.26 d）. There were postoperativeanastomotic leakage in 8 cases,wound infection in 2 cases, perianal infection in 15 cases, anastomotic stenosis were of 3 cases respec- tively. 205 patients were followed-up for 5 - 24 months,the mean time was 16 months. Local recurrence were found in 9 cases （3.4%）. The survival rate was 94.6%. Conclusion The inersphincteric resection for ultral-low rectal cancer and anal cancer could achieve satisfactory short and long term quality, might fessible and safety.