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目的探讨比较保肛术和 Miles 术治疗直肠癌的临床疗效。方法对1980年1月至2006年12月572例直肠癌手术的术后并发症、复发率、转移率和5年生存率等进行回顾性对比分析。结果 403例患者接受保肛术治疗,169例接受 Miles 术。随访时间为0.5～25.0年,中位随访时间为9.5年,随访率为76.2%(436/572)。术后总的局部复发率为6.7%(29/436),各种保肛术式为6.3%(20/317),Miles 术为7.6%(9/119),差异无统计学意义(x~2=1.3942,P>0.05)。术后总的远处转移率为15.8%(69/436),各种保肛术式为15.7%(50/317),Miles 术为16.2%(19/119),差异无统计学意义(x~2=1.3942,P>0.05)。术后总体5年生存率为67.6%(295/436),其中保肛术为67.8%(215/317),Miles 术为67.2%(80/119),套入式结肠直肠黏膜吻合保肛术为72.5%(132/182)。比较术后5年生存率套入式结肠直肠黏膜吻合保肛术略有提高,但差异无统计学意义(x~2=0.6672,P>0.05)。结论直肠癌保肛术后局部复发率和5年生存率与 Miles 术基本相当,但患者生活质量得到明显提高。直肠癌术式应根据病变部位、生物学特性、临床分期进行个体化选择。
Objective To compare the clinical efficacy of anal sphincter preservation and Miles surgery in the treatment of rectal cancer. Methods Retrospective analysis was performed on the postoperative complications, recurrence rate, metastasis rate and 5-year survival rate of 572 rectal cancer patients from January 1980 to December 2006. Results 403 patients underwent anal sphincter treatment and 169 underwent Miles surgery. The follow-up time ranged from 0.5 to 25.0 years. The median follow-up time was 9.5 years. The follow-up rate was 76.2% (436/572). The total postoperative local recurrence rate was 6.7% (29/436), the various anal sphincter procedures were 6.3% (20/317), Miles surgery was 7.6% (9/119), the difference was not statistically significant (x ~ 2 = 1.3942, P> 0.05). The total distant metastasis rate after operation was 15.8% (69/436), various anal sphincter preservation procedures were 15.7% (50/317) and Miles surgery was 16.2% (19/119), with no significant difference (x ~ 2 = 1.3942, P> 0.05). The overall 5-year overall survival rate was 67.6% (295/436), of which 67.8% (215/317) were for anal sphincter preservation and 67.2% (80/119) for Miles operation. The anastomosis of intussusception 72.5% (132/182). Comparing the survival rate of 5-year postoperative intussusception of colorectal mucosa slightly improved, but the difference was not statistically significant (x ~ 2 = 0.6672, P> 0.05). Conclusion The local recurrence rate and 5-year survival rate of rectal cancer after anal sphincter preservation are almost the same as those of Miles operation, but the quality of life of patients with rectal cancer is obviously improved. Rectal cancer surgery should be based on the lesion, biological characteristics, clinical staging for individual selection.