63例中低位直肠癌保肛术的临床疗效分析

Clinical Analysis of 63 Cases of Anus Preserving Operation for Middle and Low Rectal Cancer

目的探讨中低位直肠癌保留肛门术式的安全性和可行性。方法对63例中下段直肠癌患者按直肠癌根治原则行全直肠系膜切除（TME）,盆腔侧壁淋巴结清扫,然后施行Dixon手术,对手术方法、术后并发症、术后肛门功能恢复情况等进行评价。结果 63例患者术后未发生吻合口瘘和吻合口狭窄及大便失禁现象。术后早期排便次数较多,6~10次/d,服止泻药后能有效控制排便次数。患者随诊均超过3年。3年以上无瘤生存率88%（56/63）,5年以上无瘤生存率76%（48/63）。局部复发率17.4%（11/63）,3年内局部复发6.3%（4/63）。3年的肝转移率4.7%（3/63）。结论直肠癌切除,采用直肠肛管Dixon术,可避免结肠造口,有效防止吻合口瘘,是一种安全有效的直肠癌保肛术式。

Objective To explore the safety and feasibility of the anus preserving operation for middle and low rectal cancer. Methods 63 cases of middle and lower rectal cancer patients according to the rectal cancer radical principle for total mesorectal excision（TME）and pelvic side wall of lymph node dissection,and then in the implementation of Dixon surgery. Operative methods,postoperative complications,postoperative anal function recovery were evaluated. Results No anastomotic leakage,anastomotic stricture and fecal incontinence occurred in 63 patients after operation. Early postoperative defecation times were more, 6 ~ 10/d,taking angidiarrheal can effectively control the defecation frequency. All patients were followed up for more than 3 years. More than 3 years disease-free survival rate was 88%（56/63）,more than 5 years disease-free survival rate was 76%（48/63）. The local recurrence rate was 17.4%（11/63）,local recurrence within 3 years 6.3%（4/63）. 3 years of liver metastasis rate was 4.7%（3/63）. Conclusion Resection of rectal cancer,using the anorectal Dixon operation,colostomy can be avoided,effective to prevent anastomotic fistula,it is a safe and effective rectal cancer operation.