套入式结肠直肠黏膜吻合术治疗低位直肠癌86例的临床研究

Colorectal mucosa anastomosis for the treatment of low rectal cancer: report of 86 cases

目的探讨低位直肠癌保留肛门括约肌功能最理想的治疗术式。方法对86例低位直肠癌切除后经肛门行套入式结肠直肠黏膜吻合术。肿瘤下缘距肛缘6～7cm62例,8～10cm24例。结果全组无手术死亡,无吻合口瘘和吻合口狭窄发生。术后8～12周时排便功能控制良好,排便次数为1～4次/d,18周时肛门排便功能基本恢复正常,排便次数为1～2次/d。术后随访3个月至8年,总的局部复发率为3.7%(3/81),总的5年生存率为66.7%(14/21)。结论套入式结肠直肠黏膜吻合术可避免腹部结肠造口,并防止吻合口瘘的发生,作为低位直肠癌保肛手术,是一种安全的术式。

Objective To evaluate a novel operative modality with sphincter preservation for the treatment of low rectal carcinoma. Methods Eighty six cases of low rectal cancer were operated on with combined abdominal excision and colorectal mucosa anastomosis. The distance between the anal verge and the lower margin of the tumor was 6～7 cm(62 cases) and 8～10 cm(24 case). Results No operative mortality, anastomotic fistula and anastomotic stenosis were found in all the cases.Defecation was under satisfactory control 8～12 weeks postoperationally and returned to normal at 18th week. Mean follow up time was 49 months (3～96 months). Local recurrence developed in 3.7%(3/81 cases), and 5 year survival rate accounted for 66.7% (14/21cases). Conclusion Colorectal mucosa anastomosis is a safe and effective method for the treatment of low rectal carcinoma with sphincter preservation.