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目的:探讨扩大根治手术在低位直肠癌保肛手术中的临床意义。方法:在265例低位直肠癌中选择155例实施保肛手术,对其中62例在扩大根治手术同时完成保肛手术。保肛扩大手术选择标准,高中分化腺癌,浸润到深肌层以上,环周度≥1/2周,肠旁淋巴结肿大者,低分化腺癌,未分化腺癌。保肛术式,支撑吻合管经肛门环扎式结肠-直肠(肛管)吻合术,术后随访1～3年,寿命表法计算生存率,徐忠法,五项10分标准评价排便功能。结果:上方淋巴结转移率53.4％;侧方淋巴结转移率17.2%,下方淋巴结转移率0%,转移度9.1％。吻合平面:耻骨直肠肌25例,解剖肛管(齿线)23例,肌间沟14例。吻合狭窄3例,吻合瘘1例,术后随访结果:扩大保肛组3年生存率73.1％,局部复发率0％;一般保肛组:3年生存率65.2%,局部复发率5.16％。排便功能:优占80％,可占16.5％,差占3.5％。结论:扩大根治手术可有效防止低位直肠癌保肛手术后局部复发,扩大保肛手术适应证,排便功能良好,不增加手术合并症。
Objective: To explore the clinical significance of extended radical resection in anus-preserving operation for low rectal cancer. METHODS: One hundred and fifty-five cases of low rectal cancer were selected for sphincter preserving operation. Of these, 62 cases underwent sphincter preserving surgery at the same time of extended radical surgery. Anal enlargement surgery selection criteria, high-grade differentiated adenocarcinoma, infiltrates deep muscle layer, circumpherance ≥ 1/2 week, paraneoplastic lymph nodes, poorly differentiated adenocarcinoma, undifferentiated adenocarcinoma. The anus-preserving operation supports the anastomotic anastomosis of the anus through the cerclage colon-rectal (anal) anastomosis. The follow-up period is 1 to 3 years. The life table method is used to calculate the survival rate. Xu Zhongfa and five items of 10 points are used to evaluate the defecation function. Results: The rate of lymph node metastasis was 53.4%; the rate of lateral lymph node metastasis was 17.2%, the rate of lymph node metastasis was 0%, and the degree of metastasis was 9.1%. Anastomosis plane: 25 cases of puborectalis, anatomical anal canal (dental line) in 23 cases, 14 cases of intermuscular sulcus. Anastomotic stenosis in 3 cases, anastomotic fistula in 1 case, postoperative follow-up results: expanded sphincter preservation group 3-year survival rate of 73.1%, local recurrence rate of 0%; general sphincter preservation group: 3-year survival rate of 65.2%, local recurrence rate of 5.16%. Defecation function: Excellent 80%, 16.5%, and 3.5%. Conclusion: Extended radical surgery can effectively prevent the local recurrence of low rectal cancer after sphincter preserving operation, expand the indication of sphincter preservation surgery, and have good defecation function without increasing surgical complications.