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低位直肠癌中选择部分病例实施保肛手术是可行的。本文报道了选择62例低位直肠癌在扩大根治术基础上,保留肛门括约肌,术式为经肛门环扎式结肠一直肠(肛管)吻合术。术后上方淋巴结转移率53.4%,侧方淋巴结转移率17.2%,下方淋巴结转移率0%,转移度9.10%。随访1~3年,未见盆腔软组织、淋巴结、吻合口复发。因肝转移死亡5例。影响低位直肠癌保肛术后生存率主要原因是血行转移,不是局部复发。低位直肠癌中合理选择手术适应证和保证根治的前提下积极实施保肛手术是可行的。
It is feasible to select some cases to perform sphincter preserving surgery in low rectal cancer. This article reports on the selection of 62 cases of low rectal cancer based on the extended radical resection, retaining the anal sphincter, surgical transanal cerclage colon has been an intestinal (anal) anastomosis. 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 9.10%. Followed up for 1 to 3 years, no recurrence of pelvic soft tissue, lymph nodes, and anastomosis were observed. Five patients died due to liver metastases. The main reason affecting the survival rate of low rectal cancer after anus-preservation is hematogenous metastasis, not local recurrence. It is feasible to actively perform sphincter preserving operation under the premise of reasonably selecting surgical indications and guaranteeing radical cure in low rectal cancer.