CAJ | 학술논문

目的探讨低位直肠癌保肛手术治疗直肠癌的临床应用和疗效评价。方法回顾分析我院2004年3月~2007年5月间收治的48例直肠癌患者进行保肛根治术的临床资料，通过分析保肛根治术的应用，疗效评价，术后并发症，复发率和1年、3年、5年生存率，并与同期收治的45例经传统Miles术式治疗的患者来比较二者疗效。结果48例直肠癌患者行直肠吻合术均一次成功，无手术中死亡。术后发生吻合口瘘并发症3例，吻合口狭窄4例，术后吻合口出血患者2例，均经保守治疗治愈。复发9例，其中吻合口复发6例，盆腔复发3例。对患者进行长期随访，1年、3年、5年生存率分别达到91.7%、81.3%、66.7%。与经Miles术式治疗的45例患者比较，患者保存肛门排便功能，术后生活质量提高，在复发率和术后生存率方面无显著差异，>0.05。结论应用吻合器对低位直肠癌患者实施保肛根治术，成功率高，疗效好，并发症少，术后生活质量高等优势，与传统的Miles术式比较，在术后生活质量方面具有显著优势，同时并未增加复发率和降低生存率。值得在临床上推广应用。
목적탐토저위직장암보항수술치료직장암적림상응용화료효평개。방법회고분석아원2004년3월~2007년5월간수치적48례직장암환자진행보항근치술적림상자료，통과분석보항근치술적응용，료효평개，술후병발증，복발솔화1년、3년、5년생존솔，병여동기수치적45례경전통Miles술식치료적환자래비교이자료효。결과48례직장암환자행직장문합술균일차성공，무수술중사망。술후발생문합구루병발증3례，문합구협착4례，술후문합구출혈환자2례，균경보수치료치유。복발9례，기중문합구복발6례，분강복발3례。대환자진행장기수방，1년、3년、5년생존솔분별체도91.7%、81.3%、66.7%。여경Miles술식치료적45례환자비교，환자보존항문배편공능，술후생활질량제고，재복발솔화술후생존솔방면무현저차이，>0.05。결론응용문합기대저위직장암환자실시보항근치술，성공솔고，료효호，병발증소，술후생활질량고등우세，여전통적Miles술식비교，재술후생활질량방면구유현저우세，동시병미증가복발솔화강저생존솔。치득재림상상추엄응용。
Objective To investigate the clinical application and ef icacy of anus-preserving radical resection in treatment of patients with lower rectal carcinoma. Methods Clinical data of anus-preserving radical resection,which were performed on 48 cases with lower rectal carcinoma by peforming anus-preserving radical resection during Mar,2004 through May,2007,were retrospectively analyzed.To evaluate the ef icacy of anus-preserving radical resection by analyzing the application ,ef icacy,complication relapse rate and survival rate of 1year,3years and 5 years.And to compare the treatment ef ect between the patients receiving anus-preserving radical resection and traditional Miles. Results 48 cases who received anus-preserving radical resection were al successful y once,no patient died during operation.Postoperative anastomosis fistula and stenosis occur ed in 3 cases,and 4 cases respectively, while postoperative anastomotic bleeding occurred in 2 cases.Al complication were cured by conservative treatment. 9 cases relapsed,6 cases of them occur ed in anastomosis and 3 others occur ed in pelvic cavity. To conduct a long-term fol ow-up and the survival rate of one-year,three years and five years were 91.2%,80.9%and 66.2%. Compared with the traditional miles ,the patients keep defecation function and improve postoperative quality of life,meanwhile,they it has no significant dif erence in relapse rate and survival rate. Conclusion The application of? stapling device to conduct anus-preserving radical resection in treatment of patients with lower rectal carcinoma has many advantages ,for example:high success rate ,bet er ef icacy,less complication and high postoperative quality of life.Compared with the traditional miles ,the patients have significant advantages in postoperative quality of life,at the same time it did not increase the rate of relapse and reduce the survival rate. It deserves popularization in clinic.