超低位前切除术治疗中低位直肠癌的远期疗效

Effect of ultralow anterior resection with total mesorectal excision on mid and low rectal cancers.

目的 评价全直肠系膜切除 (totalmesorectalexcision ,TME)及采用单 /双钉合技术 (singleordoublestaplingtechnique ,SSTorDST)保肛治疗中低位直肠癌的近、远期临床疗效。方法 1997年 3月至 1998年 3月间对 96例中低位直肠腺癌行超低位DST/SST前切除术 ,其中根治性切除 87例 ,姑息性切除 9例。结果 全组无手术死亡及术中严重并发症 ;吻合口距齿状线在 2～ 3cm左右 ;无残端癌 ;无吻合口瘘 ,术后直肠 阴道瘘 1例 ( 0 1% ) ,肛周盆腔感染 2例 ( 2 1% ) ,吻合口出血 5例 ( 5 2 % ) ,吻合口狭窄 14例 ( 16 1% )。根治术后 5年局部复发率 8 1% ,远处转移率 2 7 6% ,5年无病生存率及 5年累积生存率分别为 64 4%和 70 1%。术后 12～ 18个月时排便次数及控便功能接近正常状态 ,无完全性排便失禁。结论 TME超低位DST/SST前切除术根治与功能的双重效果良好 。

Objective To assess prospectively the real benefits of total mesorectal excision(TME)in the surgical treatment of rectal cancer.Methods From 3,1997 to 3,1998,96 consecutive patients with primary mid and low rectal carcinomas underwent ultralow anterior resection according to the principle of total mesorectal excision(TME)with single or double stapling technique(SST or DST).No patients had a defunctioning ileostomy.87 cases had radical resection and 77 cases had autonomic nerve preservation(ANP).Results No operative mortality and clinical anastomotic leak were observed.One patient had rectum-vagina leaks and tow cases had low-grade pelvic infection.Locoregional recurrence rate was 8.1% and distant metastases occurred in 27.6% of patients within five years.Conclusion TME is compatible with ANP and sphincter preservation provides excellent local control and may be as efficacious as routine operation for mid and low rectal cancers.