经肛管内外括约肌间切除术在超低位直肠癌保肛治疗中的应用

Intersphincteric resection in sphincter-sparing surgery for ultra-low rectal cancer

目的分析经肛管内外括约肌间切除术在超低位直肠癌保肛术中的应用效果。方法选取2013年12月至2015年4月本院收治的47例超低位直肠癌患者为研究对象,随机分为治疗组(n=24,行经肛管内外括约肌间切除术)与对照组(n=23,行直肠低位前切除术)。记录两组术后并发症发生情况,评价3个月、6个月、12个月肛门功能及肛门失禁情况。结果两组术后并发症总发生率差异无统计学意义(P>0.05)。两组术前肛门功能评分、肛门失禁评分比较,差异无统计学意义(P>0.05)。术后3个月、6个月、12个月两组肛门功能评分及肛门失禁评分较术前显著降低(均P<0.05);术后3个月、6个月、12个月治疗组肛门功能评分及肛门失禁评分均显著低于对照组(均P<0.05)。结论在超低位直肠癌保肛治疗中,与直肠低位前切除术相比,经肛管内外括约肌间切除术改善患者术后肛门失禁及肛门功能更优。

Objective To investigate the effect of intersphincteric resection in sphincter-sparing surgery for ultra-low rectal cancer.Methods Forty-seven patients with ultra-low rectal cancer treated in the hospital between December 2013 and April 2015 were selected as study subjects and were randomly assigned treatment group（n =24,treated by intersphincteric resection）and control group（n =23,treated by rectal low anterior resection）. The incidence of postoperative complications was recorded. Anal function and incidence of anal incontinence were evaluated at 3,6 and 12 months after surgery. Results The incidence of postoperative complications was similar between the two groups（P 〈 0.05）. The anal function score and anal incontinence scores showed no significant difference before surgery and 12 months after surgery（P 〉 0.05）. The anal function score at 3,6,and 12 months after surgery were significantly lower than that before surgery. The anal incontinence scores at 3,6,and 12 months after surgery were significantly lower than those before surgery,and the decreases in treatment group at 3 and 6 months after surgery were significantly larger than those in control group（P 〈0.05）. Conclusion Intersphincteric resection is an effective way to preserve the anal function.