低位直肠癌保肛手术

Ano-saving operation for low rectal carcinoma

就国内外低位直肠癌保肛手术的适应证 ,合理的的切除范围、下切缘、直肠全系膜切除、侧方清扫 ,保肛手术术式选择 ,术后随访局部复发率、5年生存率 ,对肝转移的诊断、预防和治疗等问题复习相关文献 ,以评价低位直肠癌保肛手术的根治性和可行性。综合要点如下 :(1 )根据肿瘤位置、浸润深度、盆腔淋巴结转移状况等决定低位直肠癌保肛手术适应证。 (2 )术前肛门指诊、直肠腔内超声、盆腔CT及MRI可指导手术适应证的选择。 (3)遵循直肠全系膜切除 ,但必须进行侧方淋巴结清扫。 (4)超低位切除是低位直肠癌保肛手术主要术式。 (5)在保肛手术的同时要治疗和预防肝转移。资料说明 ,在低位直肠癌中选择适应性病例实施保肛手术可达到根治目的 ,并具有良好的生存质量。

We summarized and evaluated the radical effect and feasibility of the ano-saving operation for low rectal carcinoma by reviewing literature in recent years about the operative indication, the excision dimension, total mesorectum excision, selection of operative mode, 5-year survival rate and follow-up of the anal saving operation in low rectal carcinoma.The main points are as follows: (1)The operative indication of ano-saving operation is done according to the location,invasion depth and pelvic lymphatic metastasis of low rectal carcinoma.(2)The preoperative digital anal examination,rectal intraluminal ultrasound,pelvic CT and MRI can direct the selection of operative indication.(3)The operation of low rectal carcinoma should adhere to total mesorectum excision,but the lateral lymphadenectomy is necessary.(4)The wtra low resection is the major operative mode for low rectal carcionoma.(5)We should simultaneously perform the ano-saving operation through treating and preventing hepatic metastasis.The ano-saving operation can not only have radical treatment effect,but also improve the quality of life in patients with low rectal carcinoma.