超低位直肠癌保肛手术的可行性研究  

STUDY ON THE FEASIBILITY OF ANAL-PRESERVING OPERATION FOR ULTRA-LOW RECTAL CARCINOMA

作　　者：李德川[1] 冯海洋[1] 刘勇[1] 陈贤贵[1] 楼荣灿[1] 曹浩明[1] 

机构地区：[1]浙江省肿瘤医院,浙江杭州310022

出　　处：《肿瘤研究与临床》2003年第4期242-244,共3页Cancer Research and Clinic

摘　　要：目的 :探讨超低位直肠癌保肛手术的可行性和手术方式。方法 :对我院 2 0 0 1年 1月— 2 0 0 2年 10月 15例超低位直肠癌 (肿瘤下缘距肛缘≤ 5 cm者 )保肛手术的临床病理学特点、手术方式、术后肛门功能及预后情况进行分析。结果 :本组 15例 ,男性 6例 ,女性 9例 ;肿瘤距肛缘 4 cm者 4例 ,4 .5 cm者 5例 ,5 cm者 6例 ;病理类型属中分化腺癌者 12例 ,中 -低分化腺癌 3例。均行经腹全直肠系膜切除、结肠肛门吻合术。Dukes′分期 :A期 8例 ,B期 2例 ,C期 5例。随访 7个月～ 2 8个月 ,1例术后 2 0个月盆腔淋巴结转移再手术 ,1例术后 18个月发现肝肺转移化疗中。无局部复发 ,目前均存活。肛门功能 :2个月～ 3个月恢复预感便意 ,5个月～ 6个月恢复控便能力 ,平均每天排便 3次～ 4次。术后 6个月排便节制优良率达 80 %。无肛门失禁。结论 :对于肿瘤病灶局限、分化良好、患者情况良好 ,同时具备相当的手术经验 ,超低位直肠癌的保肛手术是可行的。Objective:To study the surgical methods and the feasibility of anal preserving procedure for ultra low rectal cancer.Methods:From January,2001 to October,2002,15 patients with ultra low rectal cancer treated by anal preserving procedure were recruited to study the characteristic of clinical pathology ,the method of operation ,the function of anus after operation and the prognosis.Results:The distance from tumor to anus edge: four cases were 4 cm, five cases 4.5 cm and six cases 5 cm. The type of pathology: 12 patients were middle differentiation and 3 patients were middle low differentiation. All of the cases were treated by total mesorectal excision(TME) and colo anal anastomosis. Pathological stage: Dukes′A 8 cases, Dukes′B 2 cases, Dukes′C 5 cases. Follow up for 7～28 months, metastasis of liver and lung was found in one patient after 18 post operative months and metastasis of perineal lymph node was found in another patient who was treated with surgery after 20 months.No local recurrence and all were alive. All the patients recovered the excretion intention within 2～3 months, excretion control within 5～6 months and can excrete averaging 3～4 times everyday. Postoperative anal continence was achieved with satisfaction in about 80 % patients after 6 months, and no incontinence occur.Conclusion:The anal preserving operation can be performed by surgeons with rich experience on the radical resection, the TME technique and the sphincter preserving procedure for low rectal cancer. It can be selected in ultra low rectal cancer with localized tumor, well differentiation and good general condition.

关 键 词：超低位 直肠癌 保肛手术 

分 类 号：R734.5[医药卫生—肿瘤]