经肛门内括约肌切除术治疗超低位直肠癌51例报告  

Intersphincteric resection with direct coloanal anastomosis for ultra-low rectal cancer:a report of 51 cases

作　　者：魏广辉[1] 韩加刚[1] 王振军[1] 易秉强[1] 高志刚[1] 马华崇[1] 杨勇[1] 

机构地区：[1]首都医科大学附属北京朝阳医院普通外科,北京100020

出　　处：《中国实用外科杂志》2012年第11期932-934,共3页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金资助项目(30772123);北京市卫生系统领军人才(2009-1-03)

摘　　要：目的评价内括约肌切除术(ISR)治疗超低位直肠癌的并发症、生存结果和肛门功能预后。方法 2000年3月至2009年8月首都医科大学附属北京朝阳医院普通外科对51例超低位直肠癌实施了ISR,其中完全ISR6例,部分ISR23例,保留部分齿状线的部分ISR(改良的部分ISR)22例。结果术后9例出现术后并发症,其中伤口感染2例,吻合口漏2例,吻合口狭窄4例,盆腔脓肿1例,无围手术期死亡。术后5年存活率95%,5年无瘤存活率92%。术后随访12个月,接受部分ISR(P=0.008)和改良的部分ISR(P=0.000)病人肛门功能优于完全ISR;接受预防性造口病人的肛门功能优于未接受造口者(P=0.022)。结论 ISR选择性治疗超低位直肠癌安全可行。吻合口狭窄是ISR术后常见的并发症。预防性造口、采用改良的部分ISR手术有助于改善术后肛门功能。Objective To evaluate the complications, oncological and functional outcomes of intersphincteric resection （ISR） in ultra-low rectal cancer. Methods From March 2000 to August 2009, ISR with total mesorectal excision was performed in 51 patients with very low rectal cancer （total ISR in 6 patients, partial ISR in 23 patients and modified partial ISR in 22 patients） in Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University. Results Postoperative complications occurred in 9 patients, such as wound infection （2 patients）, anastomotic leakage （2 patients）, anastomotic stricture （4 patients） and pelvic abscess （1 patient）, without perioperative mortality. The 5-year overall survival rate was 95%, and 5-year disease-free survival rate was 92%. Patients performed partial ISR （P= 0.008） and modified partial ISR （P=O.O00） both had significantly better continence than those performed total ISR, and patients with diverting stoma had significantly better continence （P=0.022） than those without stoma at 12 months after operation. Conclusion ISR is safe and feasible for ultra-low rectal cancer. Anastomotic stricture is the common postoperative complication of ISR. A temporary diverting stoma and modified partial ISR showed better anal function and less rate of incontinence.

关 键 词：低位直肠癌 内括约肌切除术 吻合口狭窄 

分 类 号：R6[医药卫生—外科学]