CAJ | 학술논문

目的评价超低位直肠癌行括约肌间切除手术(ISR)后的肛肠动力学变化、肛门功能及肿瘤根治效果.方法总结分析2004年1月至2007年8月问施行ISR手术的30例超低位直肠癌患者的临床资料.结果 30例患者肿瘤距肛缘2.5～4.0(平均3.4)cm.与术前比较,术后肛管静息压、肛门最大收缩压和直肠最大耐受容积明显降低(P<0.01),有27例(90.0%)患者术后肛门直肠抑制反射消失,且随着时间推移无明显恢复.按Williams的排便自制标准,术后3、6、12个月分别有86.7%、93.3%和96.7%的患者达到功能良好效果.全组患者随访1年至3年8个月,无死亡病例;未出现盆腔或吻合口局部复发、远处转移和吻合口瘘.10例术后出现肛周粪渍性湿疹,2例结肠黏膜脱出,1例肛管狭窄.结论 ISR超低位吻合保肛手术治疗低位直肠癌可以达到良好的根治性,并能较好地保留肛门功能.
목적 평개초저위직장암행괄약기간절제수술(ISR)후적항장동역학변화、항문공능급종류근치효과.방법 총결분석2004년1월지2007년8월문시행ISR수술적30례초저위직장암환자적림상자료.결과 30례환자종류거항연2.5～4.0(평균3.4)cm.여술전비교,술후항관정식압、항문최대수축압화직장최대내수용적명현강저(P<0.01),유27례(90.0%)환자술후항문직장억제반사소실,차수착시간추이무명현회복.안Williams적배편자제표준,술후3、6、12개월분별유86.7%、93.3%화96.7%적환자체도공능량호효과.전조환자수방1년지3년8개월,무사망병례;미출현분강혹문합구국부복발、원처전이화문합구루.10례술후출현항주분지성습진,2례결장점막탈출,1례항관협착.결론 ISR초저위문합보항수술치료저위직장암가이체도량호적근치성,병능교호지보류항문공능.
Objective To evaluate anorectal dynamics, function and efficacy of ultralow rectal carcinoma patients undergone intersphincterie resection (ISR). Methods From January 2004 to August 2007, 30 patients with ultralow rectal carcinoma (2.5-4.0 cm distance from anal edge) underwent ISR.All the patients received anorectal manometry before and after operation. The postoperative anal function was evaluated by Williams continence standard and the treatment outcome was followed up.Results After ISR operation, anal resting pressure, maximum squeeze pressure and maximum tolerance volume of the rectum decreased significantly (all P<0.01) and restored gradually, but not to normal. The rectal anal inhibitory reflex disappeared in 27 patients (90.0%) and was not improved.According to Williams continence standard, 86.7%, 93.3% and 96.7% of patients obtained acceptable anal function in 3, 6, and 12 months after operation respectively. During follow-up of 12 to 44 months, all the patients were still alive and no patient developed pelvis or local recurrence,distant metastasis and anastomotic leakage. Fecal eczema of anus occurred in 10 patients, colonic mucosa prolapse in 2 patients and stenosis of anal canal in one patient. Conclusion ISR for ultralow rectal carcinoma can not only attain radical treatment outcome, but also preserve anal sphincter.