根治性经括约肌间切除术治疗低位直肠癌的远期疗效观察

Long-term outcomes of radical intersphincteric resection for low rectal cancer

目的评估经括约肌问切除术（ISR）对低位直肠癌实施根治性切除的远期疗效（包括肿瘤学效果及肛门功能）。方法对2006年2月至2013年5月采用ISR进行RO切除术并成功保肛的91例低位直肠癌患者的临床资料进行回顾性分析。结果术后病理分期pTNMⅠ期35例、Ⅱ期30例、Ⅲ期26例。无围术期死亡。发生吻合口瘘2例，新直肠黏膜坏死2例，吻合口狭窄15例。术后随访6～94个月。平均随访（403±239）个月。中途失访10例。远处转移9例，局部复发3例，1例术后36个月发现左侧盆壁淋巴结转移，1例术后35个月骶前复发，1例术后52个月发现骶骨转移。无吻合口复发。随访截止时，8例死于肿瘤远处转移。5年累积生存率90．9％，5年累积无病生存率81．3％。至术后1年。行部分、次全、完全ISR患者肛管最大静息压分别为（85±1．4）、（7．9±2．2）、（4．4±1．2）kPa，大便失禁严重程度Vaizey评分为4．2±3．0、5．7±3．0、13．7±3．2。结论在进行RO切除的前提下，低位直肠癌患者使用ISR技术进行保肛治疗具有较低局部复发率以及可以接受的肛门节制功能。

Objective To assess the long-term outcomes of radical intersphincteric resection （ISR） for ultra-low rectal cancer. Methods Ninety one consecutive patients with ultra-low rectal cancer underwent sphincter-preserving procedure with curative intersphincteric resection between February 2006 and May 2013. The clinic data were analyzed retrospectively. Results The TNM staging was TNM Ⅰ in 35 cases, TNM Ⅱ in 30 and TNM Ⅲ in 26. There was no perioperative death. Postoperative anastomotic leakage was found in 2 patients, new rectal mucosal necrosis in 2 patients, and anastomotic stenosis in 15 patients. The mean duration of follow-up was 40.3 ± 23.9 months （6-94）, and 10 patients were lost for follow up. During the follow up, distant metastasis occurred in 9 cases and local recurrence in 3, and no anastomotic recurrence was found; 8 patients died by the end of the follow-up due to tumor metastasis. Log-Rank survival analysis showed that the cumulative 5-year survival rate was was 90.9% and cumulative disease-free 5-year survival rate was 81.3%. One year after operation, the maximum resting pressure of anal canal were（8.5 ±1.4）kPa, （7.9 ±2.2）kPa and （4.4 ±1.2） kPa; the Vaizey scores of fecal incontinence were 4.2 ± 3.0, 5.7 ±3.0 and 13.7 ±3.2 for partial ISR, subtotal ISR and total ISR, respectively. Conclusion Under the precondition of R0 resection, ultra-low rectal cancer patients treated with ISR have low local recurrence and acceptable anal function.