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目的:探讨直肠拖出双吻合器保肛术在超低位直肠癌治疗中的临床效果。方法:对35例超低位直肠癌患者实施拖出式双吻合器保肛手术治疗,观察手术情况、术后吻合口瘘、排便、排尿及性功能等。结果:所有患者均顺利完成手术,无术中死亡,无1例改行腹会阴切除术(APR)。术后肠管断端切缘无肿瘤残留,术后吻合口瘘1例,术后1年出现吻合口狭窄1例;所有患者术后1个月均能自行控制排便,术后3个月排便基本恢复正常;术后1个月排尿功能恢复正常。18例(78.3%)男性患者勃起功能正常;10例(83.3%)女性患者性兴奋能力恢复正常。随访9个月至3年随访,至今均良好存活,随访中1例术后10个月肿瘤复发,再次手术切除后至今存活。结论:拖出式双吻合器保肛手术在超低位直肠癌中疗效确切,能够在保证根治的基础上最大限度保留肛门功能,且对排尿、性功能等方面影响较小,值得广泛应用。
Objective: To investigate the clinical effect of rectal pull-out double stapler sphincter preservation in the treatment of ultra-low rectal cancer. Methods: Thirty-five patients with ultralow rectal cancer were treated with drag-and-pull double stapler anal sphincter preservation operation. The operative conditions, anastomotic fistula, defecation, urination and sexual function were observed. Results: All the patients were successfully performed the operation without any death and none of them underwent transurethral resection (APR). There was no residual tumor at the resection margin of the intestine, 1 case had anastomotic fistula postoperatively, and 1 case had anastomotic stenosis at 1 year after operation. All patients were able to control the defecation one month after operation and the basic defecation at 3 months Returned to normal; 1 month after urination function returned to normal. Eighteen patients (78.3%) had normal erectile function, while 10 (83.3%) women returned to normal sexual excitement. Follow-up of 9 months to 3 years of follow-up, so far have survived well, follow-up in 1 case of tumor recurrence 10 months after surgery again after surgical excision survived. CONCLUSIONS: Drag-and-pull double stapler anal sphincter preserving surgery is effective in treating ultralow rectal cancer. It can maximally preserve anus function on the basis of radical cure, and has less influence on urination and sexual function, which is worthy of wide application.