【作者】 戴勇； 姜金波； 张晓明； 马喆； 毕冬松； 靳祖涛； 孙靖中；

【Author】 DAI Yong, JIANG Jin-bo, ZHANG Xiao-ming, MA Zhe, BI Dong-song JIN Zu-tao, SUN Jingzhong. (Department of general surgery, radiation and ultrasonic, Qilu hospital of Shandong University, Jinan, China, 250012)

【机构】 山东大学齐鲁医院普外科； 山东大学齐鲁医院放射科； 山东大学齐鲁医院超声科；

【摘要】 目的:评估超低位直肠癌外翻脱出式内括约肌切除的根治和保肛效果。方法:对2000年1月～ 2004年6月23例下缘距肛缘<5cm、外括约肌、肛提肌未受累,以及术前肠镜活检肿瘤为高 -中分化的低位直肠癌病人采用内括约肌切除术,切除直肠系膜和部分内括约肌,行结肠肛管吻合。观察病人术后肿瘤局部复发等指标以及对粪便的控制情况。结果:Dukes分期:Dukes A,7例(30．4％),B期11例(47．8％),C期5例(21．7％)。肿瘤下缘距肛缘的平均距离为 4．5(3．5～5．0)cm,平均远切缘是1．6(1．0-2．0)cm。术后并发症:2例(8．7％)病人出现吻合口瘘,2例(8．7％)病人出现吻合口狭窄。平均随访时间是31．5(12～54)个月;2例(8．7％) 出现术后局部复发,3例(13．0%)死于肿瘤远处转移。术后12个月对固体、液体和气体粪便均能很好控制为87．0％(20／23),对固体粪便控制良好、偶尔对液体粪便不能控制为8．7％ (2／23),对固体粪便控制良好、经常对液体粪便不能控制为4．4％(1／23),无完全失禁病例。术后3、6、12、24、36个月平均排便次数分别为13．1、4．7、3．1、2．9、3．2次/天。肛管静息压术后明显下降,术后3月略有回升但仍保持在较低水平;最大收缩压手术后也有降低,但 6月后又明显上升,12月后维持在较高水平。结论:低位直肠癌内括约肌切除的根治效果和肛门功能较为满意,是一种有价值的低位直肠癌保肛手术。更多还原

【Abstract】 PURPOSE Evaluation of the continence function and oncologic results of intersphincteric resection with prolapsing technique for low rectal cancer. METHODS Only tumors with distal margin for tumors located 5 cm and lower from the anus, no evidence of infiltration of either external sphincter, puborectalis or the levator in the MRI as well as with a well-to-moderate differentiation in the preoperative biopsy were eligible for intersphincteric resection and coloanal anastomosis.This procedure is performed by a synchronous abdominoperineal approach with mesorectal excision and excision of the entire or part of the internal sphincter. The patients were evaluated prospectively according to a detailed preoperative and postoperative program. RESULTS From 2000.1~2004.6, thirteen patients were operated on. Median distance from the anal margin is 4.5 (range,3.5-5.0) cm. Mean distal cut margin is 1.6(range,1.0~2:0)cm. Cancers were staged according to the Dukes classification (Stage A in 30.4%, Stage B in 47.8%, and Stage C in 21.7%). Postoperative complications were: two cases (8.7%) developed an anastomotic fistula, two patients(8.7%) developed late strictures of the coloanal anastomosis. After a median follow-up of 31.5 (12-54) months, two patients (8.7%) developed local recurrence. Three patient(13.0%) died because distal metastasis. Continence for solid, liquid stool, and flatus in 20 patient (87.0%), continence for solid stool but occasionally incontinence for liquid stool only in 2 patients (8.7%), and continence for solid stool but frequently incontinence for liquid stool incontinence in 1 patient (4.4%) after intersphincteric resection. The median frequency of defecation per day of postoperative 3, 6, 12, 24 months was 13.1,4.7, 3.1, 2.9, 3.2. Anal manometry measurements showed a decrease of the resting pressure after intersphincteric resection, which remained constant during the whole observation period. Contrary to this, the maximum squeeze pressure, which also dropped greatly after resection, increased during the long-term follow-up. CONCLUSIONS Intersphincteric resection is a valuable procedure for sphincter -saving rectal surgery. We showed that this technique has satisfactory results in functional and oncologic respects.更多还原