中国实用外科杂志

中国实用外科杂志

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经肛门内括约肌切除术治疗超低位直肠癌51例报告

魏广辉，韩加刚，王振军，易秉强，高志刚，马华崇，杨    勇   

  1. 首都医科大学附属北京朝阳医院普通外科，北京100020
  • 发布日期:2012-10-19

  • Published:2012-10-19

摘要：

目的    评价内括约肌切除术（ISR）治疗超低位直肠癌的并发症、生存结果和肛门功能预后。方法    2000年3月至2009年8月首都医科大学附属北京朝阳医院普通外科对51例超低位直肠癌实施了ISR，其中完全ISR 6例，部分ISR 23例，保留部分齿状线的部分ISR（改良的部分ISR）22例。 结果    术后9例出现术后并发症，其中伤口感染2例，吻合口漏2例，吻合口狭窄4例，盆腔脓肿1例，无围手术期死亡。术后5年存活率95%，5年无瘤存活率92%。术后随访12个月，接受部分ISR（P= 0.008）和改良的部分ISR（P= 0.000）病人肛门功能优于完全ISR；接受预防性造口病人的肛门功能优于未接受造口者（P= 0.022）。 结论    ISR选择性治疗超低位直肠癌安全可行。吻合口狭窄是ISR术后常见的并发症。预防性造口、采用改良的部分ISR手术有助于改善术后肛门功能。

关键词: 低位直肠癌, 内括约肌切除术, 吻合口狭窄

Abstract:

Intersphincteric resection with direct coloanal anastomosis for ultra-low rectal cancer：a report of 51 cases　              WEI Guang-hui, HAN Jia-gang, WANG Zhen-jun, et al. Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
Corresponding author: WANG Zhen-jun, E-mail: wang3zj@sohu.com
Abstract    Objective    To evaluate the complications, oncological and functional outcomes of intersphincteric resection (ISR) in ultra-low rectal cancer. Methods    From March 2000 to August 2009, ISR with total mesorectal excision was performed in 51 patients with very low rectal cancer (total ISR in 6 patients, partial ISR in 23 patients and modified partial ISR in 22 patients) in Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University. Results    Postoperative complications occurred in 9 patients, such as wound infection (2 patients), anastomotic leakage (2 patients), anastomotic stricture (4 patients) and pelvic abscess (1 patient), without perioperative mortality. The 5-year overall survival rate was 95%, and 5-year disease-free survival rate was 92%. Patients performed partial ISR (P= 0.008) and modified partial ISR (P=0.000) both had significantly better continence than those performed total ISR, and patients with diverting stoma had significantly better continence (P=0.022) than those without stoma at 12 months after operation. Conclusion    ISR is safe and feasible for ultra-low rectal cancer. Anastomotic stricture is the common postoperative complication of ISR. A temporary diverting stoma and modified partial ISR showed better anal function and less rate of incontinence.

Key words: low rectal cancer, intersphincteric resection, anastomic stricture