CAJ | 학술논문

目的：探讨经肛门括约肌间切除术(ISR)治疗T1和T2期超低位直肠癌的肿瘤根治效果及术后肛门功能。方法回顾性分析2004年1月至2013年12月山东省枣庄市立第四医院外科收治的102例实施ISR手术的T1和T2期超低位直肠癌患者的临床资料,其中切除全部内括约肌者33例(完全ISR组),切除部分内括约肌者39例(部分ISR组),保留部分齿状线者30例(保齿ISR组)﹔所有手术均遵循全直肠系膜切除原则。比较3组患者手术根治情况及术后肛门功能。采用Williams分级标准评估术后肛门功能。结果3组患者一般资料比较差异无统计学意义(均P>0.05)。3组患者手术时间、术中出血量、切除肠管长度、远切缘距离、清扫淋巴结数目、切缘阴性情况及术后并发症发生率的比较差异也无统计学意义(均P>0.05)。术后12月,部分ISR组和保齿ISR组的肛门功能良好率均为100%,明显优于完全ISR组的75.8%(25/33),差异具有统计学意义(x2=4.654,P=0.015)。结论 ISR治疗T1和T2期超低位直肠癌安全有效,在保证根治性的前提下应尽可能保留部分内括约肌和齿状线,以改善术后肛门功能。
목적：탐토경항문괄약기간절제술(ISR)치료T1화T2기초저위직장암적종류근치효과급술후항문공능。방법회고성분석2004년1월지2013년12월산동성조장시립제사의원외과수치적102례실시ISR수술적T1화T2기초저위직장암환자적림상자료,기중절제전부내괄약기자33례(완전ISR조),절제부분내괄약기자39례(부분ISR조),보류부분치상선자30례(보치ISR조)﹔소유수술균준순전직장계막절제원칙。비교3조환자수술근치정황급술후항문공능。채용Williams분급표준평고술후항문공능。결과3조환자일반자료비교차이무통계학의의(균P>0.05)。3조환자수술시간、술중출혈량、절제장관장도、원절연거리、청소림파결수목、절연음성정황급술후병발증발생솔적비교차이야무통계학의의(균P>0.05)。술후12월,부분ISR조화보치ISR조적항문공능량호솔균위100%,명현우우완전ISR조적75.8%(25/33),차이구유통계학의의(x2=4.654,P=0.015)。결론 ISR치료T1화T2기초저위직장암안전유효,재보증근치성적전제하응진가능보류부분내괄약기화치상선,이개선술후항문공능。
Objective To evaluate the radical effect and postoperative anal function of total mesorectum excision (TME) combined with different intersphincter resection (ISR) in treatment of T1 and T2 stage ultra-low rectal cancer. Methods Clinical data of 102 T1 and T2 stage ultra-low colorectal cancer patients who received TME combined with different ISR from January 2004 to December 2013 in our department, including 33 cases of complete internal anal sphincter excision ISR (complete ISR group), 39 cases of partial internal anal sphincter excision ISR(partial ISR), 30 cases of partial dentate line reservation ISR (dentate line group). All the operation procedures followed the principles of TME. Radical conditions were compared and similarly, postoperative anal function was evaluated by Williams classification standard among 3 groups. Results The general information, such as gender, age, BMI, maximum diameter of tumor, distance of tumor edge to dentate line, TNM staging, degree of differentiation among 3 groups had no statistically significant differences (all P>0.05). The operation time, intraoperative blood loss, length of removed intestinal canal, resection margin, the harvested number of lymph nodes, and postoperative complications among 3 groups also had no statistically significant differences (all P>0.05). Twelve months after surgery, good anal function rate in part ISR group and dentate line group was 100%, significantly better than that incomplete ISR group (75.8%) with significant difference (x2=4.654, P=0.015). Conclusion TME combined with ISR surgery in treatment of T1 and T2 stage ultra-low rectal cancer is safe and effective, which, as far as possible to preserve partial internal sphincter and dentate line on the premise of the guarantee of radical condition, can help to improve the postoperative anal function.