中、低位直肠癌外科治疗保留患者排便功能的可行性探讨

Feasibility of surgical treatment of middle or lower rectal cancer on defecation in patients

目的:比较保肛手术与Miles手术疗效,探讨其对患者排便功能和生活质量的影响。方法:回顾性分析1991/1998收治的75例中、低位直肠癌病例,手术治疗的方法以及预后。结果:28例行前切除根治术超低位吻合。20例以吻合器行低位端端吻合,绒毛状腺瘤恶变2例行局部切除术,2例行结肠拉出术,均成功保留了肛门。23例患者行Miles手术。保肛率69.33%。经随访,保肛组局部复发4例(4/52),占7.69%,5年生存率为73.07%(38/52),Miles手术组局部复发率为2例(2/23),占8.69%,5年生存率为69.56%(16/23)。结论:低位直肠癌中选择部分病例实施保肛手术是可行的,5年生存率和局部复发率与Miles手术无差异。

AIM:To compare the effects of sphincter preservation therapy and abdominoperineal excision operation and to investigate their influence on the defecation and quality of life of patients. METHODS:The operation methods for 75 patients with middle or lower rectal carcinoma and their prognosis were analyzed retrospectively from 1991 to 1998. RESULTS:Twenty eight patients were performed sphincter preservation operation by handsewn coloanal anastomosis.Twenty patients were performed sphincter preservation operation by end to end anastomosis.Two patients with villous adenoma underwent transanal resection.Two patients underwent pull through operation.All the 62 cases preserved their anuses successfully.Twenty three patients were performed Miles operation.The sphincter preservation rate was 69.33%.The local recurrence rate of the sphincter preservation group and the abdominoperineal excision group were 7.69%(4 cases,4/52) and 8.69%(2 cases,2/23)respectively,according to the follow up.The five year survival rate of the sphincter preservation group and the abdominoperineal excision group were 73.07%(38/52)and 69.56%(16/23) respectively. CONCLUSION:There was no significant difference between the sphincter preservation group and the abdominoperineal excision group in the five year survival rate and the local recurrence rate.The sphincter preservation operations may be an excellent option in the treatment of lower rectal carcinoma for the selected patients.