中下段直肠癌全直肠系膜切除肛门外超低位吻合96例报告

The Study on Radical Excision of Middle-lower Section Rectum Cancer to Retain Physiological Anus

目的:对中下段直肠癌在根治性切除前提下,探索肛门外超低位吻合的手术方式。方法:将近10年收治的270例中下段直肠癌患者随机分成3组,治疗组96例,行全直肠系膜切除,肛门外超低位吻合;Miles组88例,行腹会阴联合直肠癌根治术;Dixon组86例,经腹直肠癌切除术。对比3组的5年生存率、局部复发率、吻合口瘘及肛门功能恢复情况,并进行统计学处理。结果:全组无手术死亡。5年生存率:治疗组67.7%(65/96),Miles组63.6%(56/88),Dixon组62.7%(54/86)。局部复发率:治疗组2.0%(2/96),Miles组4.5%(4/88),Dixon组11.6%(10/86)。吻合口瘘:治疗组2.0%(2/96),Dixon组9.3%(8/86)。远端残留直肠不同长度对肛门排便功能的影响:齿状线上残留1cm直肠,术后1个月恢复;残留2cm直肠,术后3周恢复,残留3～4cm以上直肠,术后2周后即可恢复正常。结论:本术式根治性切除彻底可靠,费用少,并发症少,远端直肠至少保留2cm才能使保留的肛门符合生理要求。

Objective:Explore the middle-lower section rectum cancer excision to retain physiological anus in precondition of radical cure.Methods:To stochasticly divided the same term patients suffer from middle-lower section rectum cancer into investigation group(96patients),comparison Miles group(88patients),and Dixon group(86patients),compare3group's5-year sur-vival rate,local relapse rate,anastomose ora fistula and anus function resume,and process statis-tic dispose.Results:No operation death in patients of total groups.5years survival rate:investi-gation group68.0%,Mils's group64.0%,Dixon group63.0%.local relapse rate:investigation group2.0%(2/96),Mile's group4.5%(4/88),Dixon group12.0%(10/86).Anastomose ora fistula:investigation group2.0%(2/96),Dixon group9.0%(8/86).the influence of anus defecate function by differ length of terminal ruclimental rectum:Parks(4patients)3-6months resume,leave den-tation line1cm,1month recover,2cm3weeks recover,3-4cm2weeks recover.Conclusion:This operation type excision downright and credibility,fewer syndrome,at least hold2cm farness rec-tum could retain physiological anus.