内括约肌切除术治疗超低位直肠癌的远期疗效报道  

Long-term results of intersphincteric resection for ultra-low rec- tal cancer

作　　者：张亚杰[1] 张浩波[1] 林谋斌[1] 陆兴生[1] 吕克之[1] 韩意[1] 尹路[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《国际外科学杂志》2013年第8期534-536,F0003,共4页International Journal of Surgery

摘　　要：目的探讨采用内括约肌切除术（ISR）治疗超低位直肠癌的临床疗效。方法对60例肿瘤下缘距肛缘〈5cm的超低位直肠癌患者行内括约肌切除术并进行临床资料分析。其中男性39例，女性21例，年龄30—77岁，平均55岁，肿瘤下缘距肛缘平均距离42mm（28～50mm）。结果60例患者均成功实施ISR，术后发生吻合口瘘3例，吻合口狭窄2例。术后中位随访时问为49个月（18～90个月），肿瘤局部复发6例，远端转移4例。5年总体生存率和5年无病生存率分别为88．3％和83．3％。53例患者术后或造口回纳术后12个月平均每日大便次数为（3．8±1．3）次，73．6％的患者排便功能良好（Kirwan Ⅰ～Ⅱ级）。结论对于癌灶局限在直肠壁内的超低位直肠癌患者行内括约肌切除术既可达到肿瘤根治的效果，又保留了良好的肛门控便功能。Objective To evaluate the long-term therapeutic results of intersphincteric resection ISR） in the treatment of ultra-low rectal cancer. Methods Sixty cases of ultra-low rectal cancer with the inferior border of the tumor within 5 cm to the edge of anus underwent intersphincteric resection （ISR） , and the clinical data were analyzed retrospectively. There were 39 males, 21 females and their average age was 55 years old （ range from 30 to 77 years old）. The inferior border of the tumor were from 28 to 50 mm to the edge of anus, averaging 42 ram. Results Sixty patients underwent intersphincteric resection successfully with 3 cases developing anastomotic leakage and 2 cases anastomotic stenosis postoperatively. After a median follow-up period of 49 months （range from 18 to 90 months）, local and distant recurrence were observed in 6 and 4 patients respectively. Five-year overall survival rate and disease-free survival rate were 88.3% and 83.3% respectively. The mean stool frequency were （3.8 ± 1.3 ） times in each day based on data from 53 patients, and the stool control function of 73.6% of all patients was preserved satisfactorily according to Kirwan classification. Conclusions This study indicated that intersphincteric resection might be a candidate technique in the treatment of early stage ultra-low rectal cancer restricted within rectal wall and could achieve satisfactory long-term results in both oncologic and functional respects.

关 键 词：超低位直肠肿瘤 内括约肌切除术 肛管 功能恢复 治疗效果 

分 类 号：R735.37[医药卫生—肿瘤]