论文部分内容阅读
目的:直肠癌保留肛门括约肌手术选择标准。探讨影响直肠癌保肛手术适应证选择因素。方法:回顾性分析1994年4月至2004年12月721例直肠癌外科治疗经验,肿瘤部位:直乙交界69例,直肠上段141例,直肠中段199例,直肠下段312例。经腹会阴切除手术(abdominoperinealresection,APR)227例,保留肛门括约肌(sphincterpreservationoperation,SPO)手术481例,其中Dixon手术449例;拖出保肛手术12例;“J”Pouch20例,Hartman手术13。SPO组与APR组比较:性别、年龄、肝脏转移、肿瘤长径、浸润深度、Dukes分期等无明显统计学差异;与有无合并低位肠梗阻、癌肿部位、组织学分化程度、侵犯周径、淋巴结转移以及根治程度差异有统计学意义。结果:根治性切除660例,根治性切除率为91·54%,SPO481例,保留肛门率为66·71%,低位直肠癌中SPO为135例,低位直肠癌保肛率43·69%(135/309)。手术死亡率0·42%(3/721),并发症发生率4·2%(30/721)。手术后局部复发率为5·41%(39/721),SPO组中位生存时间为(65·00±6·87)个月;5年生存率为59·26%;APR组中位生存时间为(42·23±5·63)个月,5年生存率为42·3%。Longrank检验Chi-Sqare为18·14;P<0·001,Overallcomparisons检验Wilcoxon为22·42;P<0·001。结论:直肠癌在确保根治前提下首选SPO,低位直肠癌根据肿瘤部位、浸润深度、分化程度、淋巴结转移状况及手术者经验选择SPO适应证。低位直肠癌中选择部分病例进行SPO是可行的。
Objective: Rectal cancer preservation of anal sphincter surgery selection criteria. To investigate the factors affecting the choice of rectal cancer sphincter preservation surgery. METHODS: Retrospective analysis was performed on 721 cases of rectal cancer surgical treatment from April 1994 to December 2004. The tumor sites included 69 cases of the border of the straight B, 141 cases of the upper rectum, 199 cases of the rectum, and 312 cases of the lower rectum. There were 227 cases of abdominoperineal resection (APR) and 481 cases of sphincter preservation operation (SPO) were retained. Of these, 449 cases were Dixon operation; 12 cases were pulled out of sphincter preserving operation; 20 cases were “J” Pouch, and 13 cases were Hartman operation. SPO group and APR group: gender, age, liver metastasis, tumor length, depth of invasion, Dukes staging, etc. There was no statistically significant difference; with or without low intestinal obstruction, cancer site, histological differentiation, invasion circumference There was a statistically significant difference in lymph node metastasis and the degree of radical cure. Results: Radical resection of 660 cases, radical resection rate was 91.54%, SPO 481 cases, retention anus rate was 66.71%, low rectal cancer SPO was 135 cases, low rectal cancer sphincter preservation rate 43.69% ( 135/309). The operative mortality rate was 0.42% (3/721) and the complication rate was 4.2% (30/721). The local recurrence rate after operation was 5.41% (39/721). The median survival time in the SPO group was (65.00±6.81) months; the 5-year survival rate was 59.26%; the median survival rate in the APR group. The time was (42.23±5.63) months, and the 5-year survival rate was 42.3%. Longrank tests Chi-Sqare at 18·14; P<0.001, and Overallcomparisons tests Wilcoxon at 22·42; P<0·001. Conclusions: Rectal cancer is the first choice of SPO to ensure radical treatment, and low rectal cancer is based on tumor location, depth of invasion, differentiation, lymph node metastasis, and surgical experience to select SPO indications. It is feasible to select some cases for SPO in low rectal cancer.