CAJ | 학술논문

目的：探讨低位直肠癌根治手术在不同时期保肛率的变化及其因素分析。方法将2003年7月～2008年6月收治的79例设为远期组，收治的2008年7月~2013年6月的104例设为近期组（采用全直肠系膜切除术）。根据所有患者是否施行保肛手术而分为ARP组45例和SP组138例。结果远期组和近期组两种不同手术方式比较，差异有统计学意义（P＜0.05）。SP术两组比较，差异有统计学意义（P＜0.05）。肿瘤周径＜1/2周～全周四者的保肛率依次下降，差异有统计学意义（P＜0.05）。肿瘤大体分型中，肿块型、溃疡型及浸润型及肿瘤病理呈高、中、低分化癌者三者的保肛率呈现依次下降的趋势（P＜0.05）。低位直肠癌Dukes A～D期四者保肛率也呈现逐渐下降的趋势。结论全直肠系膜切除术在一定程度上提高了低位直肠癌的保肛率。肿瘤周径、肿瘤病理分期、肿瘤主体位置、肿瘤大体分型、肿瘤分化程度及患者的性别及BMI等均可对低位直肠癌手术保肛产生影响。
목적：탐토저위직장암근치수술재불동시기보항솔적변화급기인소분석。방법장2003년7월～2008년6월수치적79례설위원기조，수치적2008년7월~2013년6월적104례설위근기조（채용전직장계막절제술）。근거소유환자시부시행보항수술이분위ARP조45례화SP조138례。결과원기조화근기조량충불동수술방식비교，차이유통계학의의（P＜0.05）。SP술량조비교，차이유통계학의의（P＜0.05）。종류주경＜1/2주～전주사자적보항솔의차하강，차이유통계학의의（P＜0.05）。종류대체분형중，종괴형、궤양형급침윤형급종류병리정고、중、저분화암자삼자적보항솔정현의차하강적추세（P＜0.05）。저위직장암Dukes A～D기사자보항솔야정현축점하강적추세。결론전직장계막절제술재일정정도상제고료저위직장암적보항솔。종류주경、종류병리분기、종류주체위치、종류대체분형、종류분화정도급환자적성별급BMI등균가대저위직장암수술보항산생영향。
Objective To explore the changes and factors of anus preservation rate in anus-protection operation on low rectal cancer in different periods. Methods 79 cases during July 2003 to June 2008 were classified as the long-term group,while 104 cases during July 2008 to June 2013 were classified as the short-term group,the patients in the short-term group were treated with the total mesorectal excision.All patients were divided into 45 cases of group ARP and 138 cases of group SP according to whether or not undergo anus preserving operation. Results The difference was statistically significant between the early group and late group(P < 0.05). SP comparison of two groups,the difference was statistically significant(P < 0.05). APR group of the inferior margin of the tumor distance from the anal verge was smaller than that of SP group, the anal preservation rate in less than 1/2 tumor diameter,1/2-3/4 tumor diameter,>3/4 tumor diameter and total tumor diameter decreased by turns(P<0.05),and that in mass type,ulcer type and infiltration type of tumor gross type and in high,medium, low differentiated carcinoma and in Dukes A,B,C,D phase of low rectal cancer also decreased by turns(P < 0.05). Conclusion Total mesorectal excision improves the anus preservation rate of low rectal cancer at some extent.Tumor diameter, tumor staging,tumor location,tumor body gross type,tumor differentiation and sex of the patients and BMI can affect the anus-protection operation in low rectal cancer.