后盆腔次全切除术治疗女性低位直肠癌273例  

Subtotal posterior pelvic exenteration for the treatment of low rectal carcinoma in women

作　　者：李东华[1] 郁宝铭[1] 黄粱[1] 陆爱国[1] 郑民华[1] 

机构地区：[1]上海第二医科大学瑞金医院外科,200025

出　　处：《中华普通外科杂志》2002年第2期80-82,共3页Chinese Journal of General Surgery

摘　　要：目的探讨在女性低位直肠癌患者中行后盆腔清除术时兼行保肛手术的可能性。方法自 195 4年 1月至 1999年 12月共收治女性直肠癌 10 2 7例 ,其中 718例为低位直肠癌 ,能行根治性切除者 5 70例 ,占 79 4% ,行后盆腔清除术者 2 73例占 47 9%。按不同时期分二组 ,Ⅰ组 195 4～ 1989年 ,低位直肠癌 36 6例 ,行后盆腔清除术者 2 0 6例 ,占 5 6 3% ,其中 2 2例行后盆腔清除低位前切除 (后盆腔次全切除 ,简称次全切除组 ) ,占 10 7%。Ⅱ组 1990～ 1999年 ,低位直肠癌 2 0 4例 ,行后盆腔清除术 6 7例 ,占 32 8% ,其中 2 6例行次全切除 ,占 38 8%。二组病例在病理学类型、组织学分类和病理分期上均无差异。结果总手术死亡率 3 3% ,二组之间无差异 ,分别为 3 4%和 3 0 %。 48例行清扫保肛手术者发生吻合口漏 4例 (8 3% ) ,均发生于Ⅰ组 ,故Ⅰ组吻合口漏发生率高达 18 2 %。全组术后局部复发 13例 ,占 4 8% ,其中Ⅰ组复发 9例 (4 4% ) ,Ⅱ组 4例 (6 0 % ) ,P >0 0 5。 13例均复发于盆腔 ,无吻合口复发。Ⅰ组 5年生存率 (5 3 2± 1 9) % ,Ⅱ组 (6 7 3± 1 6 ) % ,P <0 0 5。结论女性低位直肠癌患者在行后盆腔清除时 ,对合适的病例兼行保肛手术不但可行 ,而且不会增加局部复发率。Ⅱ组 5年生存率的提高则是我们?ObjectiveTo probe into the feasibility of performing an anus-preserving female low rectal carcinoma resection after subtotal posterior pelvic exenteration.Methods From Jan. 1954 to Dec. 1999, 1?027 female patients with rectal carcinoma were admitted, among them 718 cases were of low recal carcinoma and 570 cases underwent curative resecetion. 273 (47.9%) cases received posterior pelvic exenteration. Those were divided into two groups, group Ⅰ consisted of 366 cases from 1954 to 1989, 206 (56.3%) cases underwent posterior pelvic exenteration among them 22 (10.7%) cases were treated by sphincter-saving resection (subtotal posterior pelvic exenteration). Group Ⅱ consisted of 204 cases from 1990 to 1999, 67 (32.8%) cases were treated with posterior pelvic exenteration, among them 26 (38.8%) cases were subjected to subtotal posterior pelvic exenteration.ResultsOverall operative mortality rate was 3.3% and there was no significant difference between the two groups (3.4% vs 3.0%). Anastomotic leakage occurred in 4 cases following subtotal pelvic posterior exenteration in overall 48 cases with an incidence of 8.3% and all occurred in group Ⅰ. Overall local recurrence occurred in 13 (4.8%) patients. There were 9 cases in group Ⅰ (4.4%) and 4 cases in Group Ⅱ (6.0%), P>0.05. All arose in the pelvis. 5 year′s survival rate in group Ⅰ was (53.2±1.9)% and (67.3±1.6)% in group Ⅱ, P<0.05.ConclusionsIn properly selected cases female low rectal carcinoma could be safely treated by anus-preserving resection combined with subtotal posterior pelvic exeneration. The 5 year′s survival rate of this procedure is quite favorable.

关 键 词：直肠肿瘤 盆腔脏器除去术 女性 低位 

分 类 号：R735.37[医药卫生—肿瘤] R730.56[医药卫生—临床医学]