直肠癌低位保肛手术指征及手术要点  

Analysis of surgical indications and methods for keeping anus operation in treatment of middle-lower segment rectum cancer

作　　者：孙杨忠[1] 刘素君[1] 郑建伟[1] 吴浩良[1] 宋慧敏[1] 王云雷[1] 韩晓风[1] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区普外科,北京100043

出　　处：《临床和实验医学杂志》2007年第11期37-37,39,共2页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨直肠癌低位保肛手术指征及手术要点。方法回顾性分析我科2002年1月至2007年3月应用消化道吻合器治疗23例低位直肠癌的临床资料。结果全组无手术死亡、无手术并发症，随访至今无复发。结论我们认为直肠癌低位手术保肛的指征是：①直肠肿瘤下缘距肛缘超过5cm；②早期直肠癌局限于肠壁内，其直径小于3em；③进展期癌侵犯肠壁周径小于1／2，未侵肠壁浆膜层以及累及其周围组织、器官；④乳头状腺瘤恶变，或分化度为Ⅰ-Ⅱ级腺癌。手术要完全依从肿瘤根治、淋巴结清扫的规范，下切缘在肿瘤下方2—3cm，上切缘在乙状结肠的中上段，淋巴结清扫包括乙状结肠、直肠系膜区域的淋巴结及两侧闭孔淋巴结，方可大大改善预后及提高术后生活质量。Objective To analyze surgical indications and methods for keeping anus operation in treating patients with middle - lower segment rectum cancer. Methods Retrospective analysis on clinical data of 23 cases with middle - lower segment rectum cancer treated by keeping anus operation between January 2002 and March 2007 had been carried out, Results There were no death, complications and recurrence after the operation seen in follow - up study. Conclusion The indications for keeping anus operation in treating patients with middle - lower segment rectum cancer are as follows： the distance from tumor to anus ≥5cm, the diameter of tumor ≤3 era, the range of rectum involved by the tumor ≤1/2, no infiltration of tumor cells in the serosae of intestinal wall and peripheral tissues or organs, and carcinomatous change of polypoid adenoma. The surgical methods for this operation are total mesorectal excision and cleaning up neighboring lymph nodes.

关 键 词：直肠肿瘤 直肠全系膜切除 低位保肛手术 手术指征 手术要点 

分 类 号：R735.37[医药卫生—肿瘤]