中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
8期
628-630
,共3页
李世拥%梁振家%苑树俊%于波%陈纲%陈光%左富义%白雪%魏晓军%徐一石%崔伟
李世擁%樑振傢%苑樹俊%于波%陳綱%陳光%左富義%白雪%魏曉軍%徐一石%崔偉
리세옹%량진가%원수준%우파%진강%진광%좌부의%백설%위효군%서일석%최위
直肠肿瘤%直肠结肠切除术,重建性%保肛手术%经肛门内外括约肌间切除
直腸腫瘤%直腸結腸切除術,重建性%保肛手術%經肛門內外括約肌間切除
직장종류%직장결장절제술,중건성%보항수술%경항문내외괄약기간절제
Rectal neoplasm%Proctocolectomy,restorative%Sphincter-preserving operation%Inter sphincter resection
目的 探讨经腹肛门切除肛门内括约肌的直肠癌根治保肛术治疗超低位直肠癌的临床疗效.方法 对52例癌灶下缘距肛缘4～5 cm的超低位直肠癌经腹肛门切除肛门内括约肌加结肠套叠重建内括约肌保肛术进行临床分析.52例中男29例,女23例.年龄28～76岁,平均为56.3岁.癌灶下缘距肛缘4 cm 18例,癌灶下缘距肛口5 cm 34例.病理诊断直肠腺癌52例,其中高分化者21例,中分化者29例,低分化者2例,腺瘤癌变6例.Dukes分期:A期28例,B期24例.结果 52例术后随访率为88%(46/52),术后随访时间2个月至12年,中位随访时间为5.9年.术后发生吻合口瘘2例(3.8%),吻合口狭窄3例(5.7%),术后6～12个月时肛门排便控制功能基本恢复到正常.术后局部复发3例,术后5年生存牢为24/33例(73%).结论 切除肛门内括约肌的直肠癌根治保肛术能保留良好的肛门排便控制功能,不增加局部复发率,是一种安全有效的超低位直肠癌保肛术式.
目的 探討經腹肛門切除肛門內括約肌的直腸癌根治保肛術治療超低位直腸癌的臨床療效.方法 對52例癌竈下緣距肛緣4～5 cm的超低位直腸癌經腹肛門切除肛門內括約肌加結腸套疊重建內括約肌保肛術進行臨床分析.52例中男29例,女23例.年齡28～76歲,平均為56.3歲.癌竈下緣距肛緣4 cm 18例,癌竈下緣距肛口5 cm 34例.病理診斷直腸腺癌52例,其中高分化者21例,中分化者29例,低分化者2例,腺瘤癌變6例.Dukes分期:A期28例,B期24例.結果 52例術後隨訪率為88%(46/52),術後隨訪時間2箇月至12年,中位隨訪時間為5.9年.術後髮生吻閤口瘺2例(3.8%),吻閤口狹窄3例(5.7%),術後6～12箇月時肛門排便控製功能基本恢複到正常.術後跼部複髮3例,術後5年生存牢為24/33例(73%).結論 切除肛門內括約肌的直腸癌根治保肛術能保留良好的肛門排便控製功能,不增加跼部複髮率,是一種安全有效的超低位直腸癌保肛術式.
목적 탐토경복항문절제항문내괄약기적직장암근치보항술치료초저위직장암적림상료효.방법 대52례암조하연거항연4～5 cm적초저위직장암경복항문절제항문내괄약기가결장투첩중건내괄약기보항술진행림상분석.52례중남29례,녀23례.년령28～76세,평균위56.3세.암조하연거항연4 cm 18례,암조하연거항구5 cm 34례.병리진단직장선암52례,기중고분화자21례,중분화자29례,저분화자2례,선류암변6례.Dukes분기:A기28례,B기24례.결과 52례술후수방솔위88%(46/52),술후수방시간2개월지12년,중위수방시간위5.9년.술후발생문합구루2례(3.8%),문합구협착3례(5.7%),술후6～12개월시항문배편공제공능기본회복도정상.술후국부복발3례,술후5년생존뢰위24/33례(73%).결론 절제항문내괄약기적직장암근치보항술능보류량호적항문배편공제공능,불증가국부복발솔,시일충안전유효적초저위직장암보항술식.
Objective To study clinical therapeutic effects of anus-preserving operation with resecting anal intersphincter to treat ultra-low rectal cancer through abdominal cavity. Methods We retrospectively analyzed 52 cases of ultra-low rectal cancer, with the inferior border of the cancers within 2 cm to anocutaneous line or 5 cm to the edge of anus treated by anus-preserving operation with resecting archos internal sphincter muscles through abdominal cavity and anus. There were 29 males, and 23 females, with age 28 to 76 years old, averaging 56. 3 years old. The inferior border of the cancer were within 4 cm to the edge of anus in 18 cases, including 6 cases of adenoma cancerization, and 5 cm to the anus in 34 cases. Pathologic diagnosis was well-differentiated adenocarcinoma in 21 cases, moderately differentiated in 29 cases, low differentiated in 2 cases, there were 6 cases with adenoma cancerization. 28 cases were Dukes A stage, and 24 B stage. Results The follow-up rate was 88. 4% (46/52), and the median time was 5.9 years. 2 case developed stoma leak (3.8%), and 3 developed stoma stenosis(5.7% ) after operation. The anus could roughly control defecation in 6 ～ 12 mouths after operation. The local recurrence rate was 5.7%, and the 5-year-survival rate was 72.7%. Conclusion By anus-preserving operation with resecting archos internal sphincter muscles, defecation controlling was well reserved by anus, and the 5-year-survival rate was not cut down. This operation is one of the safe and effective operations of anus-preserving procedure.
