结肠肛管套式拖出吻合术治疗低位直肠癌的临床分析

Outcome analysis of external coloanal anastomosis in the treatment of patknts with middle or lower rectal carcinoma

目的评价结肠肛管套式吻合术治疗低位直肠癌的临床安全性及效果。方法回顾性分析我院1993-2002年以来33例低位直肠癌应用结肠肛管套式拖出吻合术的治疗情况,即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,并立即送回盆腔的外科技术。结果随访5-10年,随访率100％。肛门功能正常及良好者28例,占84.8％(28/33);较差者5例,占15.2％(5/33)。本组1例放疗后完全失去大便控制能力,改为Niles术。吻合口瘘1例,占3.0％。局部复发率15.2％;5年生存率60.6％(20/33),10年生存率39.4％(13/33)。结论保留肛门括约肌的结肠肛管套式拖出吻合术治疗低位直肠癌应选择合适的病例,可获得较高的生存率及生活质量。

Objective To evaluate the safety and efficacy of external coloanal anastomosis in the treatment of middle or lower rectal cancer.Methods Retrospective study on the safety and efficacy of resection and external coloanal anastomosis in treatment of 33 patients with rectal cancers. The operation was in brief to make coloanal anastomosis through an everted rectal stump,and pull back the proximal colon into the pelvic cavity.Results All postoperative patients were followed up from 5 to 10 years. Normal or good fecal continence was achieved in 84.8 % (28/33) of the patients,fair in 15.2% (5/33) .Anastomotic fistula developed in 5 patients and local recurrence rate was 15.2% . The 5, and 10 year survival rates were 60.6% and 39.4% , respectively. Conclusions Coloanal anastomosis provides effective treatment for middle and lower rectal cancer with a satisfactory long-term survival rate and quality of life.