CAJ | 학술논문

目的总结用肛门内括约肌切除术治疗超低位直肠肿瘤的临床经验.方法对26例无外括约肌受侵的低位直肠肿瘤患者行全直肠系膜切除加经肛内括约肌切除术的临床资料进行回顾性分析.对肿瘤下缘距齿状线 2 cm者,行内括约肌部分切除;肿瘤下缘距齿状线 1.0 cm、<2.0 cm者,行内括约肌次全切除;肿瘤距齿状线<1.0 cm或侵及齿状线者,行内括约肌全切除,结肠肛管行端端吻合.结果 26例患者肿瘤下缘距齿状线距离为0～3 cm.病理类型:高分化腺癌6例,中分化腺癌16例.乳头状癌1例,绒毛状腺瘤癌变1例.巨大绒毛状腺瘤2例.病理分期:pTNM Ⅰ期11例,ⅡA期8例,ⅢA期4例,ⅢB期1例;T分级:T1 8例,T2 15例,13 1例.全组无手术死亡;无吻合口瘘;发生吻合口狭窄2例.术后早期肛门经常粪污,每日大便3～10次.术后1年控便时间可达5 min以上,患者排便次数减少,最少为每日1次,或每日2～4次.但内括约肌全切除者仍偶然粪污.术后平均随访时间28个月,术后5个月吻合口肿瘤复发1例,术后10个月肝转移1例,术后26个月心源性猝死1例.结论对于癌灶局限于直肠壁内的超低位直肠癌,采用肛门内括约肌切除术可以达到根治效果,并保留肛门功能.
목적 총결용항문내괄약기절제술치료초저위직장종류적림상경험.방법 대26례무외괄약기수침적저위직장종류환자행전직장계막절제가경항내괄약기절제술적림상자료진행회고성분석.대종류하연거치상선 2 cm자,행내괄약기부분절제;종류하연거치상선 1.0 cm、<2.0 cm자,행내괄약기차전절제;종류거치상선<1.0 cm혹침급치상선자,행내괄약기전절제,결장항관행단단문합.결과 26례환자종류하연거치상선거리위0～3 cm.병리류형:고분화선암6례,중분화선암16례.유두상암1례,융모상선류암변1례.거대융모상선류2례.병리분기:pTNM Ⅰ기11례,ⅡA기8례,ⅢA기4례,ⅢB기1례;T분급:T1 8례,T2 15례,13 1례.전조무수술사망;무문합구루;발생문합구협착2례.술후조기항문경상분오,매일대편3～10차.술후1년공편시간가체5 min이상,환자배편차수감소,최소위매일1차,혹매일2～4차.단내괄약기전절제자잉우연분오.술후평균수방시간28개월,술후5개월문합구종류복발1례,술후10개월간전이1례,술후26개월심원성졸사1례.결론 대우암조국한우직장벽내적초저위직장암,채용항문내괄약기절제술가이체도근치효과,병보류항문공능.
Objective To summarize the clinical experience of interspineter resection in treating ultra-lower rectal tumor. Methods Twenty-six ultra-lower rectal tumor cases (24 cases of rectal cancer, 2 cases of giant villous adenoma) without extrasphincter involvement underwent total mesoreetal excision and interspineter resection. Partial, subtotal or total innerspineter resection was performed respectively for patients in which the tumor lower margin was over 2 cm, between 1 -2 cm, and less than 1.0 cm above thedentate line respectively. Alimentary tract continuity was constructed by end to end anastomsis of the colon and anus. Results The lower margin of tumor in 26 patients was within 0 - 3 cm above the dentate line.The pathology was highly differentiated in 6 cases and medium differentiated in 16 cases, papillary carcinoma in 2 cases, giant villous adenoma in 2 cases. There were 11 cases of stage Ⅰ , 8 of stage Ⅱ A, 4 of stage Ⅲ A, and 1 of stage Ⅲ B according to pTNM system; 8 cases of T1, 15 of T2, and 1 of T3 according to T stage criteria. There was no mortality nor major complications. Two cases suffered from anastomotic stricture. The stool seepage was common at early stage after surgery, with immediately postoperative daily defecation of 3 -10, and one year later, most patients were able to hold back the defecation impulse for more than 5 min, and have daily defecation of 0. 5 to 4 times. Occasional seepage was reported in one patient with total innersphincter resection. The average postoperative follow up was 28 months. One recurrence was found on the 5th month, one suffered from liver metastasis in the 10 month, and one died of cardiac arrest in 26 month. Conclusion To those patients with very lower rectal cancer restricted within rectal wall,interspincter resection fulfils curative purpose while preserving the anal function.