经肛门括约肌间切除术治疗超低位直肠癌根治效果及术后肛门功能观察  

Radical effect and postoperative anal function of total mesorectum excision combined with different intersphincter resection in treatment of T1 and T2 stage ultra-low rectal cancer

作　　者：马磊 丁克[2] 刘广余 张丹丹 

机构地区：[1]山东省枣庄市立第四医院外科,277599 [2]山东中医药大学附属医院肛肠科

出　　处：《中华胃肠外科杂志》2015年第7期688-692,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨经肛门括约肌间切除术（ISR）治疗T1和T2期超低位直肠癌的肿瘤根治效果及术后肛门功能。方法回顾性分析2004年1月至2013年12月山东省枣庄市立第四医院外科收治的102例实施ISR手术的T1和T2期超低位直肠癌患者的临床资料，其中切除全部内括约肌者33例（完全ISR组），切除部分内括约肌者39例（部分ISR组），保留部分齿状线者30例（保齿ISR组）：所有手术均遵循全直肠系膜切除原则。比较3组患者手术根治情况及术后肛门功能。采用Williams分级标准评估术后肛门功能。结果3组患者一般资料比较差异无统计学意义（均P〉0．05）。3组患者手术时间、术中出血量、切除肠管长度、远切缘距离、清扫淋巴结数目、切缘阴性情况及术后并发症发生率的比较差异也无统计学意义（均P〉0．05）。术后12月，部分ISR组和保齿ISR组的肛门功能良好率均为100％．明显优于完全ISR组的75．8％（25／33），差异具有统计学意义（x^2=4．654，P=0．015）。结论ISR治疗T1和T2期超低位直肠癌安全有效，在保证根治性的前提下应尽可能保留部分内括约肌和齿状线，以改善术后肛门功能。Objective To evaluate the radical effect and postoperative anal function of total mesoreetum excision （TME） combined with different intersphincter resection （ISR） in treatment of TI and T2 stage ultra-low rectal cancer. Methods Clinical data of 102 T1 and T2 stage ultra-low eoloreetal cancer patients who received TME combined with different ISR from January 2004 to December 2013 in our department, including 33 cases of complete internal anal sphincter excision ISR （complete ISR group）, 39 cases of partial internal anal sphincter excision ISR（partial ISR）, 30 cases of partial dentate line reservation ISR （dentate line group）. All the operation procedures followed the principles of TME. Radical conditions were compared and similarly, postoperative anal function was evaluated by Williams classification standard among 3 groups. Results The general information, such as gender, age, BMI, maximum diameter of tumor, distance of tumor edge to dentate line, TNM staging, degree of differentiation among 3 groups had no statistically significant differences （all P〉0.05）. The operation time, intraoperative blood loss, length of removed intestinal canal, resection margin, the harvested number of lymph nodes, and postoperative complications among 3 groups also had no statistically significant differences （all P〉0.05）. Twelve months after surgery, good anal function rate in part ISR group and dentate line group was 100%, significantly better than that in complete ISR group （75.8%） with significant difference （x^2=4.654, P=0.015）. Conclusion TME combined with ISR surgery in treatment of T1 and T2 stage ultra-low rectal cancer is safe and effective, which, as far as possible to preserve partial internal sphincter and dentate line on the premise of the guarantee of radical condition, can help to improve the postoperative anal function.

关 键 词：直肠肿瘤 超低位 全直肠系膜切除术 内括约肌切除术 根治效果 肛门功能 

分 类 号：R735.37[医药卫生—肿瘤]