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目的探讨套入式结肠直肠黏膜吻合保肛术式治疗中低位直肠癌的临床疗效。方法对208例中低位直肠癌行套入式结肠直肠黏膜吻合保肛术式经腹肛门根治性切除病例进行回顾性分析。208例中男131例,女77例,年龄21~99岁,平均53·7岁。肿瘤下缘距齿状线6~8cm。Dukes分期A期76例,B期122例,C期10例。病理诊断直肠腺癌201例,其中高分化者86例,中分化者100例,低分化者8例,黏液腺癌7例。腺瘤癌变7例。结果208例术后随访率为87·5%(182/208),中位随访时间5·9年。术后发生吻合口瘘8例(3·8%),吻合口狭窄3例(1·4%),排便功能在术后12~24周时基本恢复到正常,每日1~3次。术后局部复发率为4·9%(9/182),肝转移率为14·2%(26/182),5年生存率为72·5%。结论套入式结肠直肠黏膜吻合保肛术式既能保持良好的肛门排便控制功能,又能降低吻合口瘘发生率,局部复发率和5年生存率与Miles手术相同,是一种安全有效的保肛术式。
Objective To investigate the clinical effect of intussusferent colorectal mucosal anastomosis for the treatment of low and middle rectal cancer. Methods A retrospective analysis of 208 cases of low rectal cancer with colorectal mucosal anastomosis and anal sphincterotomy was performed retrospectively. 208 cases of male 131 cases, 77 females, aged 21 to 99 years, an average of 53.7 years. Tumor margin from dentate line 6 ~ 8cm. Dukes stage A 76 cases, B 122 cases, C 10 cases. Pathological diagnosis of rectal adenocarcinoma in 201 cases, including 86 cases of well-differentiated, moderately differentiated in 100 cases, poorly differentiated in 8 cases, mucinous adenocarcinoma in 7 cases. Adenoma canceration in 7 cases. Results 208 patients were followed up rate was 87.5% (182/208), the median follow-up time of 5.9 years. Anastomotic fistula occurred in 8 cases (3.8%), anastomotic stenosis in 3 cases (1.4%), defecation function returned to normal 12 to 24 weeks after surgery, 1 to 3 times a day. Postoperative local recurrence rate was 4.9% (9/182), liver metastasis rate was 14.2% (26/182), and 5-year survival rate was 72.5%. Conclusions The intussusception anastomosis with colorectal mucosa can maintain good anal defecation control function, reduce the incidence of anastomotic fistula, local recurrence rate and 5-year survival rate are the same as Miles operation, which is safe and effective Paul anal surgery.