经腹肛拖出式直肠癌切除术治疗早、中期低位直肠癌21例分析

Abdominal Proctectomy with Colon Stump Pulled out of Anus and Sphincter Preservation for Low Rectal Cancer of Early or Middle Stage

目的 探讨早、中期低位直肠癌保留肛门括约肌功能的理想手术方式。 方法 采用经腹肛拖出式直肠癌切除术治疗早、中期低位直肠癌 2 1例。 结果 全组无手术死亡 ,术后 1例发生肛门外拉出肠管部分坏死 ,骶前感染1例 ,无肠回缩、吻合口瘘。平均随访 2 8( 6～ 5 0 )个月 ,无局部复发。术后 18个月发现肝脏转移灶 1例 ,现仍无癌生存 2 0例。吻合口狭窄 2例。本组术后 2周拉出肠段修整后排便次数较多 ,1月后控制大便能力明显改善 ,大便 3～ 5次 /d ,3月后大便基本正常 ,1～ 2次 /d。 结论 在严格掌握手术适应证的条件下 ,经腹肛拖出式直肠癌切除术可作为治疗早、中期低位直肠癌并保留肛门功能的一种可靠术式。

Objective To investigate a better sphincter saving operative modality for the treatment of low rectal cancer of early or middle stage. Methods Abdominal proctectomy with colon stump pulled out of the anus were performed on 21 cases of low rectal cancer of early or middle stage. Results There were no operative mortality, anastomotic fistula, and local recurrence in all the cases. Mean follow-up was 28 months (6～50 months). 20 cases were free of the cancer to the end of follow-up period and one case had liver metastasis 18 months after the operation. 1 case got anteriorsacro-space infection, 2 cases had anastomotic stenosis, and there was 1 case of partial necrosis of the colon stump out of the anus. Defecation ability was improved in all cases 1 month after the operation and back to normal 3 months after the operation. Conclusion Abdominal proctectomy with colon stump pulled out of the anus may be a reliable operation modality for the treatment of low rectal cancer of early or middle stage with sphincter presevation in the presence of rigid indication.