直肠癌超低位前切除术508例临床分析  

Experience of ultralow anterior excision for rectal cancer：508 cases analysis

作　　者：刘宝善[1] 徐琳[1] 燕锦[1] 刘超[1] 郑阳春[1] 

机构地区：[1]四川省肿瘤医院普外科,成都610041

出　　处：《中华外科杂志》2008年第22期1712-1715,共4页Chinese Journal of Surgery

摘　　要：目的探讨直肠癌超低位前切除的方法及术后效果。方法将1996年10月至2006年10月收治的508例能实施保存肛门功能治疗的腹膜返折附近及其以下进展期直肠癌分为两组，其中365例行超低位前切除的器械吻合术；143例行全直肠切除的结肠-肛管吻合术。分析比较两组的手术效果及预后。结果超低位前切除组只在腹腔内操作，但撕裂远侧闭合端3例（0．9％），未完成闭合2例（0．6％），吻合器切下组织未形成2个圆圈18例（5．6％）。全直肠切除组除在腹腔内分离外，还需在肛门外进行吻合。术后排便功能（排便次数、内衣污染、便意急迫）超低位前切除组明显优于全直肠切除组（P〈0．01）；排便困难（残便感、排便时间延长、常用泻剂）两组差异亦有统计学意义（P〈0．05）。超低位前切除组12例（3．5％）和全直肠切除组8例（5．6％）发生吻合口瘘（P〉0．05）。超低位前切除组77例（22．5％）和全直肠切除组40例（27．9％）发生吻合口狭窄（P〉0．05）。超低位前切除组局部复发率为11．8％，全直肠切除组为10．1％（P〉0．05）。超低位前切除组5年生存率为68．8％，全直肠切除组为66．8％（P〉0．05）。结论两组距肿瘤下缘的切断距离不同，虽然局部复发率和5年生存率无显著差别，但排便功能与排便困难超低位前切除组则明显优于全直肠切除组。Objective To investigate the operative techniques and postoperative effects of uhralow anterior excision for rectal cancer. Methods From October 1996 to October 2006, 508 cases with rectal carcinoma at or below the peritoneal reflection with potential to preserve the anal function were divided into two groups. Of the patients,365 cases underwent uhralow anterior excision and instrumental anastomosis, and 143 cases underwent manual colon-anal anastomosis （Parks operation）. Results In the group with anterior excision, the operations were all completed in the abdominal cavity, and avulsion of distal occlusive end occurred in 3 cases （0. 9%）, unsuccessful anastomosis happened in 2 cases （ 0.6% ）, unsatisfactory anastomosis with incomplete anastomosis circle turned out in 18 cases （5.6%）. In the Parks operation group, the anastomosis was carried out manually at the anus and in abdominal cavity. Postoperative defecation function （times, soiling underpants, feeling of urgent defecation） in the group anterior excision was clearly better than that in the group of Parks operation （P〈0.05） ; difficulty of defecation （ sense of residual stool, prolonging of defecation, cathartic usage） was also better in the group with anterior excision （P〈0. 05）. The anastomosis leakage rate was 3. 5% in anterior excision group, compared to 5. 6% in Parks operation group （P 〉 0.05）. Anastomotic stenosis occurred in 77 cases （22.5%） in anterior excision group, and 40 cases （27.9%） in Parks operation group （P 〉 0.05）. The local recurrence rate and 5-year survival rate were 11.8% and 68. 8% in anterior excision group, and 10. 1% and 66. 8% in Parks operation group, respectively （ P 〉 0. 05 ）. Conclusions Although there is no significant differences in local recurrence and 5-year survival rate between the two groups, the function and difficulty of defecation with instrumental anastomosis demonstrates clear advantages over Parks operation.

关 键 词：直肠肿瘤 外科手术 超低位前切除术 

分 类 号：R686[医药卫生—骨科学]