低位直肠癌保肛手术适应症选择与评价  

Selection for Anal Preservative Operation in Low rectal Cancer and E valuation of Operative Effect

作　　者：程中[1] 肖阳[2] 胡明[3] 蔡建醛 

机构地区：[1]四川大学华西医院普外科,成都610041 [2]四川省成都市第七人民医院,610041 [3]四川省攀枝花市中心医院,617067 [4]四川省荣县人民医院,643100

出　　处：《职业卫生与病伤》2002年第1期7-9,共3页Occupational Health and Damage

摘　　要：目的 探讨低位直肠癌保肛手术适应症选择标准，评价保存肛术后临床效果。方法 根据肛门指诊、直肠腔内超声、盆腔ＣＴ、ＭＲＩ、术前活检病理，９６例低位直肠癌用美国ＪＯＨＮＳＯＮ吻合器或／和闭合器行结肠直肠（肛管）吻合术。低位直肠保肛手术适应症选择标准：高中分化腺癌、隆起型、未浸透深肌层、环周度≤１／２周，无肠旁淋巴结肿大、距齿状线１ ｃｍ以上；高中分化腺癌、溃疡型≥１／２周，浸透肠壁深肌层、无盆腔淋巴结肿大、距齿状线３ ｃｍ以上；低分化腺癌、粘液腺癌未浸透深肌层，环周度≤１／２周，无肠旁淋巴结肿大，距齿状线４ ｃｍ以上，在完成全直肠系膜切除和淋巴结清扫的基础上保留肛门。结果 全组除发生１例直肠阴道瘘外无手术死亡及其它严重并发症。寿命表法计算３年生存率７８．１％，局部复发率５．２％。术后病人排便功能优者达８４．０％，１２～１８月排便次数和排便功能接近正常状态，无完全性排便失禁。结论 低位直肠高中分化腺癌隆起型，未浸透肠壁深肌层，环周度≤１／２周，无肠旁淋巴结肿大，距齿状线１ ｃｍ以上；高中分化腺癌溃疡型≥１／２周，浸透肠壁深肌层，无盆腔淋巴结肿大，距齿状线３ ｃｍ以上。低分化腺癌、粘液腺癌未浸透深肌层，环周度≤１／２周。Objective To evaluate the selection of indication and clinical effect of anal preservative operation in low rectal cancer.Metods According to the diagnosis by touching rectum,intra rectal u ltrasound,pelvic CT,MRI,preoperative pathological diagnosis,96 patients with cancer of the low rectum were operated in anal preservation. Colon rectal or anal anastomosis completed by single or double stapling technique with Americ an Johnson anastomostic and/or stump close equipment. The standard we chose for the operation:On the basis of total mesorectal excision and extended lymph node resection,the anal preservative operation were done as follow:High and middle differentiated adenocarcinoma(type of bulge) with more than 1/2 circle,infiltra ting through the muscle of the intestine,without lymph node tumefaction,more t han 3 cm dental line. Low differentiated adenocarcinoma infiltrating less than 1/2 circle of rectum,without infiltrating through the muscle and lymph nod e tumefaction,more than 4 cm dental line.Results No pati ents in our group died and there were no serious complications caused by operat ion except 1 case of rectum vagina fistula. The 3 year surviving rate and loca l recurrence rate was 78.1% and 5.2% respectively. The defecating function of 84 % of patients recovered almost normally about 12~18 months postoperatively,no complete incontinence of faeces.Conclusion Anal preservative o peration can be done on patients as follow:high and middle differentiation adeno carcinoma(type of bulge) without infiltrating through the muscle of rectum and l ymph node tumefaction,more than 1/2 circle,3 cm above dental line; high and mi ddle diferentiation adenocarcinoma(type of ulcer)with infiltrating into the musc le of rectum,more than 1/2 circle,without pelvic lymph node tumefaction,3 cm above dental line; Low differentiated adenocarcinoma infiltrating less than 1/2 circle of rectum,without infiltrating through the muscle and lymph node tumefaction, more than 4 cm dental line. This seemed as standards in the tre

关 键 词：直肠癌 保肛手术 临床效果 治疗 

分 类 号：R735.370.5[医药卫生—肿瘤]