低位直肠癌病人肛门括约肌保留的理论探讨和手术方法改进

INVESTIGATION AND MODIFICATION OF ANTERIOR RESECTION IN PATIENTS WITH LOW RECTAL CANCER

对肿瘤距肛缘6～10cm 之直肠癌病人是否施行保留肛门括约肌手术,尚无统一意见。本文根据直肠癌病理、临床资料和直肠下端全切除术后肛肠生理状态,对低位直肠癌病人保留肛门括约肌理论进行初步探讨,并介绍经腹直肠下端全切除经肛门低位吻合手术方法。

Based on the pathological studies of 46 specimens removed in Mile's or Dixon's operation, the authorsfound that distal microscopic spread within the bowel wall usually extended less than 1.0 cm. Clinical databad showed that no significant difference could be demonstrated between those cases in which a distalclearance of more than 5 cm or less than 5 cm. If a distal length of clearance less than 3 cm, the incidenceor local recurrence was 8.3%. The physiologic status of the anorectum after complete excision of the rectumand colo-anal anastomosis was evaloated by manometric studies and the quality of life in these patientsseemed far superior. The authors discussed the rationale for preservation of the anal spbincter with lowrectal cancer and the technique of transanal colo-anal anastomosis.