盲肠痛保肛手术适应症选择（附634例分析）  

Indication Analysis of Preserving-sphincter Operation for Rectal Cancer

作　　者：李义 郭江福 陆慧敏[2] 

机构地区：[1]中国贵航集团300医院普通外科,贵州贵阳550009 [2]四川大学华西医院

出　　处：《中国肛肠病杂志》2007年第6期15-17,共3页Chinese Journal of Coloproctology

摘　　要：为探讨直肠癌保肛手术适应症，回顾性分析1996年5月至2004年1月634例直肠癌手术治疗的经验，直乙状结肠交界段癌61例，直肠上段癌124例，直肠中段癌175例，直肠下段癌274例。经腹会阴切除手术（APR）200例；保肛手术（SPO）手术423例，其中Dixon手术395例，拖出保肛手术10例，“J”Poch 18例，Hartmann手术11例。对SPO组与APR组临床病理指标和生存率进行统计学比较。结果显示，两组性别、年龄、肿瘤长径、Dukes分期等无明显统计学差异。保肛手术与有无合并低位肠梗阻、癌肿部位、侵犯周径、淋巴结转移以及根治程度有关。全组根治性切除580例，切除率为91．54％。根治性SPO423例，保留肛门率为66．71％，低位直肠癌中SPO为119例，低位直肠癌保肛率43．69％（119／272）。手术病死率0．42％（3／634），并发症发生率4．16％（26／634）。手术后局部复发率为5．41％（34／634）。SPO组中位生存时间为（62．1±5．6）月，5年生存率为60．17％；APR组中位生存时间为（40．2±6．5）月，5年生存率为40．3％（Х^2=16．23，P〈0．001;Х^2=21．57，P〈0．001）。结果表明，保肛手术必须严格掌握手术适应症，遵循根治第一、保肛第二的基本原则。低位直肠癌根据肿瘤部位、分化程度、肠周的浸润，淋巴结转移状况及手术者经验选择SPO。选择部分低位直肠癌病例进行SPO是可行的。关键词直肠癌；保肛手术；In order to explore indication criteria of sphincter preservation operation（SPO） for rectal cancer, 634 cases of rectal cancer who accepted operative treatment in author＇s department from May 1996 to Jan. 2004 were analyzed retrospectively, Among them,61 rectal turnout were located in rectal-sigmoid borderline, 124 rectal turnout in superior segment of rectum, 175 rectal turnout in intermediate piece of rectum and 274 rectal turnout in inferior segment of rectum. 200 cases were treated by abdominoperineal resection （APR）, 423 cases were treated by sphincter preservation operation（SPO）. Among the 423 cases there were 395 cases subjected to Dixon operation, 10 to Bacon operation, 18 to ＂J＂ pouch operation and 11 to Hartmann operation respectively. Clinicopathologic parameters and survival rate in APR and SPO groups were compared statistically. Results showed that in sexes, ages, mass-size and Dukes stages there were not significant differences between APR and SPO group, but in bowel obstruction, site of tumor, infiltrated circumference of intestine, lymph node metastasis and method of radical cure there were statistical significant differences. Radical excision was performed in 580 rectal cancer cases in all, and radical excision rate was 91.54%. SPO was performed in 423 cases（66.71%）. SPO was performed in 119 cases of inferior segment rectal cancer （43.69%,119/272）. Operative mortality was 0.42% （3/634） ,complication occurred in 4.16% （26/634） ,regional recurrence rate was 5.41%（34/634） after operation. Median survival time was （62. 1± 5. 6）monthes,5-year survival rate was 60. 17% in SPO group. Median survival time was （40. 2± 6. 5） monthes,5-year survival rate was 40.30% in APR group. Chi-Sqare is 16.23 by Long-rank test ,Wilcoxon is 21.57 by Overall comparisonstest （ P 〈0. 001）. The indication should strictly follow the principle of radical treatment being first and retainment of the anus being second. Selection of indication for SPO in inferior segment

关 键 词：直肠癌 保肛手术 适应症 

分 类 号：R473.73[医药卫生—护理学]