结肠肛管套式拖出吻合术治疗低位直肠癌的临床分析(附33例报告)

Clinical analysis of external coloanal anastomosis in the treatment of patients with middle or low rectal carcinoma

目的 评价结肠肛管套式拖出吻合术治疗低位直肠癌临床安全性及效果。方法 回顾性分析我院 1993～ 2 0 0 2年以来 33例低位直肠癌应用结肠肛管套式拖出吻合术。手术方法 :肿瘤切除后使直肠远端外翻 ,近端结肠经外翻的直肠拖出 ,于肛门外行结肠一期吻合 ,并立即送回盆腔。结果 随访 5～ 10年 ,随访率 10 0 %。肛门功能正常及良好者 2 8例 ,较差者 5例 ,本组 1例放疗后完全失去大便控制能力 ,改为Miles手术。本组吻合口瘘 1例 ,局部复发率 15 % ,5年生存率 6 0 % ,10年生存率 39%。

Objective To evaluate the safety and efficacy of pull through technigue in the treatment of middle or low rectal cancer. Methods Retrospective study was made on 33 patients with rectal cancer undergoing pull through reseltion in terms of the safety and efficacy. The technique was in brief to make coloanal anastomosis through an everted rectal stump, and pull back the proximal colon into the pelvic cavity. All postoperative patients were followed up from 5 to 10 years. Normal or good fecal continence was achieved in 85 % (28/33) of the patients, fair 15 % (5/33). Anastomotic fisula developed in 5 patients and local recurrence rate was 15 %. The 5 and 10 year survival rates were 60 % and 39 %, respectively. Conclusion anastomosis provides effective treatment for middle or low rectal cancer with a satisfactory long term survival rate and qualily of life.