拖出吻合术治疗中、下段直肠癌的临床研究

Outcome analysis of external coloanal anastomosis in the treatment of patients with middle or low rectal carcinoma

目的 评价拖出吻合术治疗中、下段直肠癌临床安全性及效果。方法 回顾性分析我院 1985～ 1995年 10 1例直肠癌应用拖出吻合术治疗情况 ,即肿瘤切除后使直肠远端外翻 ,近端结肠经外翻的直肠拖出 ,于肛门外行结肠肛管一期吻合 ,并立即送回盆腔的外科技术。结果 随访 5～ 10年 ,随访率 10 0 %。肛门功能正常及良好者 88例 ,占 87% (88/ 10 1) ,较差者 8例 ,占 7 9% (8/ 10 1) ,大便控制能力差者 5例 ,占 4 9% (5 / 10 1) ,本组 2例放疗后完全失去大便控制能力 ,改为Miles术。本组吻合口瘘为 5 % ,局部复发率 15 % ;5年生存率 6 4 % (6 5 / 10 1) ,10年生存率 5 8% (36 / 6 2 )。结论 保留肛门括约肌的拖出吻合术治疗中、下段直肠癌应选择合适的病例 。

ObjectiveTo evaluate the safety and efficacy of pull through technique in the treatment of middle or low rectal cancer.MethodsRetrospective study was made on 101 patients of rectal cancer undergoing pull through resection in terms of the safety and efficacy. The technique was in brief to make coloanal anastomosis through an everted rectal stump, and pull back the proximal colon into the pelvic cavity. ResultsAll postoperative patients were followed up from 5 to 10 years. Normal or good fecal continence was achieved in 87% (88/101) of the patients, fair in 7 9%(8/101), and poor in 4 9%(5/101). Anastomotic fistula developed in 5 patients (4 9%), and local recurrence rate was 15%. The 5, and 10 year survival rates were 64% and 58%, respectively. ConclusionsColoanal anastomosis provides effective treatment for middle and low rectal cancer with a satisfactory long term survival rate and quality of life.