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目的探讨直肠癌保留肛门括约肌(sphincterpreservationoperation,SPO)手术选择标准,分析影响直肠癌保肛术适应证选择的因素。方法回顾性分析1994年4月至2004年4月间,手术治疗708例直肠癌患者的临床资料,对SPO术与经腹会阴切除手术(abdominoperinealresection,APR)两组患者的临床病理指标和生存率进行统计学比较。结果本组直肠乙状结肠交界段癌66例;直肠上段癌138例;直肠中段癌195例;直肠下段癌309例。APR术227例;SPO手术481例,其中Dixon手术449例,拖出保肛手术12例,“J”Poch20例。SPO和APR术两组患者在性别、年龄、肝脏转移、肿瘤长径、浸润深度、Dukes分期等方面比较,差异无统计学意义(P>0.05);但在有无合并低位肠梗阻、癌肿部位、组织学分化程度、侵犯周径、淋巴结转移及根治程度方面比较,差异有统计学意义(P<0.05,P<0.01)。全组根治性切除660例(93.2%)。SPO术保肛率66.7%(311/481),其中低位直肠癌43.7%(135/309)。手术死亡率0.4%(3/708);术后局部复发率5.5%(39/708)。SPO组中位生存时间(65.0±6.9)个月,5年生存率59.3%;APR组中位生存时间(42.2±5.6)个月,5年生存率42.3%;两组比较P<0.01。结论直肠癌患者在确保根治前提下应首选SPO术,低位直肠癌患者根据肿瘤部位、分化程度、淋巴结转移状况及手术者经验选择SPO适应证应是可行的。
Objective To investigate the selection criteria of sphincter preservation surgery (SPO) for rectal cancer and analyze the factors influencing the selection of indications for sphincter preservation of rectal cancer. Methods The clinical data of 708 patients with rectal cancer treated by surgery between April 1994 and April 2004 were analyzed retrospectively. The clinicopathological parameters and survival rates of patients with SPO and APD were retrospectively analyzed. Statistical comparison. Results The group of 66 cases of rectosigmoid junctional junction; 138 cases of upper rectal cancer; 195 cases of rectal cancer; 309 cases of lower rectal cancer. APR surgery in 227 cases; SPO surgery in 481 cases, of which 449 cases of Dixon surgery, drag out of the anal sphincter preservation surgery in 12 cases, “J” Poch20 cases. There were no significant differences between the two groups in terms of sex, age, liver metastasis, tumor diameter, depth of invasion, Dukes stage (P> 0.05), but there was no difference between the two groups (P <0.05, P <0.01) .Conclusion: There is no significant difference between the two groups (P> 0.05). The whole group of radical resection of 660 cases (93.2%). The rate of anal sphincter preservation was 66.7% (311/481), of which 43.7% (135/309) were low rectal cancer. The operative mortality was 0.4% (3/708); postoperative local recurrence was 5.5% (39/708). The median survival time was (65.0 ± 6.9) months and the 5-year survival rate was 59.3% in the SPO group. The median survival time in the APR group was 42.2 ± 5.6 months and the 5-year survival rate was 42.3%. The P <0.01. Conclusions Patients with rectal cancer should be the first choice of SPO under the premise of radical treatment. Patients with low rectal cancer should be selected according to tumor location, differentiation, lymph node metastasis and experience of the surgeon.