低位直肠癌根治性切除套入式吻合保肛术231例临床研究  

Clinical study of 231 cases of radical excision with sphincter preservation by casing anastomosis in low rectal cancer

作　　者：李世拥[1] 梁振家[1] 苑树俊[1] 于波[1] 陈纲[1] 陈光[1] 白雪[1] 左富义[1] 魏晓军[1] 吴恩[1] 

机构地区：[1]北京军区总医院 全军普通外科中心,100700

出　　处：《中华外科杂志》2007年第17期1170-1172,共3页Chinese Journal of Surgery

摘　　要：目的探讨套入式结肠直肠黏膜吻合保肛术治疗中低位直肠癌的可行性和安全性及临床疗效。方法对231例中低位直肠癌经腹肛门根治性切除行套入式结肠直肠黏膜吻合保肛术进行回顾性分析。结果 231例术后随访率为85.3%(197/231),中位随访时间为5.9年(2个月～14年)。术后发生吻合口瘘8例(3.4%),吻合口狭窄3例(1.2%),术后12～24周时排便功能基本恢复正常。术后局部复发率为5.1%(10/197),肝转移率为15.2%(30/197)。肺转移率为2.5%(5/197),术后5年总体生存率为71.6%。结论套入式吻合保肛术既能减少吻合口瘘发生,又可保留良好的肛门排便控制功能,可显著提高患者术后生活质量,是中低位直肠癌一种安全有效的保肛术式。Objective To investigate the clinical efficacy, feasibility and safety of sphincterpreserving procedure by casing anastomosis of colon and rectal mucosa in low rectal cancer. Methods A retrospective analysis was carried out in 231 cases of low rectal cancer performed casing anastomosis. Results One hundred and ninety-seven （ 197/231, 85.3% ） cases were followed up, the median time of the follow up was 5.9 years （ range,2 months - 14 years）. Eight （3.4%） cases of stoma leak and 3 （ 1.2% ） cases of stoma stenosis were found post operation. Defecating function recovered normally （ 1-3 times per day） in 12- 24 weeks after operation in all patients. Local recurrence was found in 5.1% （10/197） of the cases. Hepatic and lung metastasis was found in 15.2% （30/197） and 2.5% （5/197） of the patients, respectively. The five-year survival rate was 71.6% totally. Conclusions The casing anastomosis procedure with sphincter preservation is safe and efficacy for low rectal cancer. With the procedure, the anal function can be preserved well, stoma leak is decreased, and the five-year survival rate is the same as Miles operation.

关 键 词：直肠肿瘤 结肠直肠外科手术 外科吻合术 

分 类 号：R735.37[医药卫生—肿瘤]