对全直肠系膜切除两种直肠癌根治术后局部复发的对比研究

Comparison in local recurrence rate between two types of radical operations of rectal cancer by total mesorectal excison

目的 比较在全直肠系膜切除原则下低前切除和腹会阴联合切除两种直肠癌根治术后局部复发率及复发形式的差异。方法 113例直肠癌患者按低前切除和腹会阴联合切除分两组,按全直肠系膜切除原则行直肠癌根治术。结果 低前切除术组与腹会阴联合切除术组总局部复发率分别为7.69％和8.20％(P>0.05);盆腔淋巴结复发率低前切除术组5.76％,腹会阴联合切除术组4.92％(P>0.05)。低前切除术组吻合口复发率1.92％。盆腔淋巴结复发率显著高于吻合口复发率(P<0.05)。结论 全直肠系膜切除原则是降低上述两种直肠癌根治术局部复发率的重要因素;全直肠系膜切除原则下保肛手术应成为中低位直肠癌的首选术式。

Objective To compare the differences in local recurrence rate and form between two types of radical operative treatment of rectal cancer on the principle of total mesorectal excison(TME) .Methods 113 cases of retal cancer were divided into two groups to undergo radical operations including the low anterior resection (LAR) and the combined abdominnal and perinea! incision (Miles) on the principle of TME. Results The total local recurrence rates of cancer in the LAR group and the Miles group were 7.69% and 8.20% , respectively( P > 0.05) . For lymph nodes in pelvic cavity, the recurrence rate in the LAR group was 5.76% , and that in the Miles group was 4.92% ( P > 0.05) .The recurrence rate for anastomotic stoma in the LAR group was 1.92% ; the recurrence rate for lymph nodes in pelvic cavity was significantly higher than that for anastomotic stoma ( P < 0.05). Conclusion The principle of TME is an important factor for reducing the local recurrence rate of rectal cancer in the two types of radical operations. The preservation of sphincter on the principle of TME should be the first choice in middle - and low - position rectal cancer.