TME经括约肌间切除术在低位直肠癌根治性保肛中的应用分析

Application of Total Mesorectal Excision in Intersphinctoric Resection for Anus-preserving Rectal Resection Patients with Lower Rectal Cancer

目的探讨全系膜切除术(total mesorectal excision,TME)经括约肌间直肠癌根治性切除术治疗低位直肠癌的应用效果。方法回顾性分析2012年1月至2015年1月本院收治的70例低位直肠癌患者的临床资料,其中行TME经括约肌间切除术治疗的36例患者作为观察组,行腹会阴联合切除术治疗的34例患者作为对照组,对比分析两组患者的手术情况、术后并发症情况及近中期疗效。结果观察组的手术时间明显长于对照组,P<0.05;两组患者的术中出血量及手术相关并发症比较,差异无统计学意义,P>0.05。两组患者的淋巴结清扫数目比较,差异均无统计学意义,P>0.05。两组患者的局部复发率、远处转移率、肿瘤相关死亡率及术后3年生存率比较,差异均无统计学意义,P>0.05。结论 TME经括约肌间切除术治疗低位直肠癌,根治效果满意,近中期疗效与腹会阴联合切除术相当,可推荐给具有保肛意愿的低位直肠癌患者。

Objective To investigate the effect of total mesorectal excision （TME） in the intersphinctoric resection （ISR） for the anal preservation treatment in lower rectal cancer patients. Methods Retrospective analysis was carried out in 70 patients operated in our hospital from January 2012 to January 2015. There were 36 patients undergone ISR as the observation group, and 34 patients treated with abdominal perineal resection as the control group. The operative status, postoperative complications, and short-term and mid-term efficacy of the two groups were analyzed. Results Operative time of the observation group was significantly longer than that of the control group （ P 〈0.05）. There was no significant difference in the amount of intraoperative blood loss, nor the surgical complications between the two groups（ P 〉0.05）. There was no statistically significant difference in the number of lymph node dissection between the two groups, with P 〉0.05. There was no significant difference in local recurrence rate, distant metastasis rate, tumor-related mortality, and postoperative 3-year survival rate between the two groups, with P 〉0.05. Conclusions The treatment of lower rectal cancer with TME of ISR has a satisfactory curative effect. The efficacy in the short- and mid-term is comparable to that of abdominoperineal resection. It can be recommended to the lower rectal cancer patients who have the desire to preserve the rectum.