拖出式Welch法治疗低位直肠癌:28例报告

Pull-through Welch procedure for the lower rectal carcinoma: a report of 28 cases

目的 探讨中下段直肠癌保留肛门括约肌功能的最佳治疗术式。方法 对 2 8例中下段直肠癌患者实施经腹经肛门拖出式Welch法低位切除术。病灶下缘距肛缘 6～ 8cm者 2 0例 ,8～ 1 0cm者8例。DukesA期 8例 ,B期 1 6例 ,C期 4例 ,切缘距肿瘤下缘的距离分别是 2 ,3 ,4cm。结果 全组无手术死亡 ,未发生吻合口瘘和吻合口狭窄。术后平均随访 30个月 ,2例于术后 1 8个月局部癌复发(7.1 % ) ,余 2 6例无癌生存。全组术后平均 8～ 1 2周排便次数及功能接近正常人。结论 拖出式Welch法直肠癌超低位切除术 ,在确保癌根治的情况下 ,保存了肛提肌和肛管内、外括约肌 ,保存了正常排便功能。

Objective To find a novel operative modality with sphincter preservation in the treatment of middle and low rectal carcinoma. Methods Pull through lower resection was performed on 28 rectal cancer patients. The distance between the anal verge and the lower margin of the tumor was 6～8cm(20 patients) or 8～10cm(8 patients), including 8 patients in Dukes A stage, 16 Dukes B and 4 Dukes C. The resected line from tumor distal margin was 2cm, 3cm, and 4cm, respectively. Results There was no operative death, anastomotic fistula or anastomotic stenosis in these cases. Mean follow up period was 30 months. Local recurrence was found in two cases (7.1%) 18 months after the operation, and 26 cases were cancer free till the end of the follow up. Defecation was satisfactorily controlled 8～12 weeks after the operation. Conclusions Pull through Welch procedure could meet the criterion of the radical resection of rectal carcinoma,and keep the internal and external sphincter muscles intact in the superior lower anterior resection. The normal defecationcan can maintain after the operation due to the preservation of internal and external sphincter muscles.