捆扎法在低位直肠癌保肛手术结肠-直肠/肛管吻合术中应用的评价

Sphincter preserving operation for treatment of lower rectal cancer

目的评价对低位直肠癌实施保肛手术的可行性。方法选择512例低位直肠癌患者用支撑捆扎法进行低位结肠-直肠/肛管吻合保肛手术(sphincterpreservingoperation,SPO),并与542例进行腹会阴联合切除术(abdomino-perinealresection,APR)的低位直肠癌患者比较5年生存率与局部复发率,同时分析保肛术后的排便功能。结果APR和SPO组总的5年生存率分别为65.2%和69.7%;局部复发率分别为6.7%和4.8%,两组比较,差异有显著性意义(P>0.05)。SPO组中:低位吻合术5年生存率与局部复发率分别为86.2%与1.4%;超低位吻合术分别为85.3%与2.5%;Park手术分别为68.7%与4.8%;Bacon手术分别为65.7%与6.3%;低位和超低位保肛术后排便功能优良率分别为91.5%和94.3%。结论对低位直肠癌病例进行SPO手术,从根治性和功能性上评价是可行的。

Objective To evaluate the feasibility of sphincter(anus) preserving operation for the treatment of lower rectal cancer. Methods Five hundred and twelve cases of lower rectal cancer underwent sphincter preserving operation and 543 cases of lower rectal cancer received abdominoperineal resection. Long term survival and local recurrence were compared with each other. Results The 5 year survial rate and local recurrence after operation were 65.2%and 6.7%for abdomino perineal resection, 86.2%and 1.4%for lower colon rectum(or anus) anastomosis,85.3%and 2.5%for super lower anastomosis, 68.7%and 4.8%for Park operation,65.7%and 6.3%for Bacon operation respectively. The overall 5 year survival rate of sphincter preserving operation was 69.7%and local recurrence rate was 4.8%. Conclusion The radical operation with sphincter preserving operation in lower rectal cancer is feasible and the quality of life can be improved without the increase of local recurrence and the decrease of 5 year survival rate.