结肠肛管吻合术不伴辅助性结肠造口(Parks’术的改进)  

Coloanal Anastomosis without Supplementary Transverse Colostomy:A Modification of Parks' Operation

作　　者：李东华[1] 郁宝铭[1] 沈耀祥[1] 王灏[1] 

机构地区：[1]上海第二医科大学附属瑞金医院,上海200025

出　　处：《浙江肿瘤》1997年第4期208-210,共3页

摘　　要：目的：评估Parks’术在低位直肠癌中的价值以及不按常规加作辅助性结肠造口是否安全。方法；1991年之前7例加作辅助性结肠造口，1991年后26例未作辅助性结肠造口，改用螺纹管支撑留置结肠内经肛门引出。结果：33例中无手术死亡．未作辅助性结肠造口组术后2例发生吻合瘘（7．69％）。术后3例发生吻合口狭窄，均是未作辅助性结肠造口组。术后局部复发3例，1例为常规辅加结肠造口组，2例为未作辅助性结肠造口组，总的复发率为9．1％。全组5年生存率82．38±3．36％，木后排便控制功能恢复至一年时达到顶点，90％感觉满意，但有10％患者诉常有粪便外溢污染内裤。结论：Parks’术作为一种保肛手术与腹会阴切除术相比可使患者生活质量明显提高，但其术后控便功能不及Dixon’术，为保证保肛手术的远期疗效，此术应严格选用。此外，采用螺纹管支撑经肛门引出方法可有效地替代常规辅助性结肠造口而避免二期关闭，是一种安全手术方法。Purpose: To evaluate the effect of Parks'operation in treatment for low rectal cancer and to evaluate the safety of modified Parks' operation without supplementary transverse colostomy. Methods: Before 1991, 7 cases were treated with supplementary transverse colostomy. After 1991, 26 cases were treated without supplementary transverse colostomy but retained a spiry tube peranal. Results: There was no operative death. Anastomotic leakage occurred in 2 cases (7. 69%) without colostomy and anastomotic stenosis occurred in 3 cases. Local recurrence occurred in 3 cases with a recurrence rate of 9. 1% (1 case with supplementary transverse colootomy and 2 cases without). 5-year survival rate was 82. 38±3. 36%. The recovery of continence was maximal at one year postoperatively. 90% of the patients were satisfied with their performance but 10% of the patients complained spillage and soiling. Conciusions: Parks' operation as one of the sphincter-saving resection has a better portoperative quality of life than abdominoperineal excision but the postoperative continence was not as good as Dixon's operation. It should be strictly used in selected cases. Meanwhile peranal intubation of a spiry tube for decompression can effectively replace the routine supplementary transverse colostomy thereby avoid second stage of operation and is regarded as a safe procedure.

关 键 词：直肠肿瘤 Parks'术 治疗 结肠肛管吻合术 

分 类 号：R735.370.5[医药卫生—肿瘤] R656.9[医药卫生—临床医学]