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经腹会阴联合直肠切除术作为治疗直肠下段癌的首选术式由来已久,但此术有一定的併发症和死亡率,凡需永久结肠造瘘,为一些患者难以接受或耐受。因此有人倡用保留直肠功能的方法,治疗‘早期’直肠癌患者。这就是能摘除癌瘤而不破坏肛门括约肌的方法,包括局部切除,电凝或腔内放疗。因为用这种局部疗法不能将区域淋巴管和淋巴结去除,临床采用严格指标只选择早期的条件有利的肿瘤。一般认为:患中度分化至高度分化癌、直径等于或小于4 cm,不固定于邻近组织者认为是局部治疗的适应证。这三项指标能排除大多数淋巴转移患者。
Transabdominal perineal resection combined with rectal resection is a long-term strategy for the treatment of lower rectal cancer. However, this procedure has certain complications and mortality. Where permanent colostomy is required, it is difficult for some patients to accept or tolerate. Therefore, some people advocate the use of preservation of rectal function to treat patients with ’early’ rectal cancer. This is a method that can remove cancer without destroying the anal sphincter, including local resection, electrocoagulation or intracavitary radiotherapy. Because regional lymphatics and lymph nodes cannot be removed with this topical therapy, clinically rigorous criteria are used to select only early-stage favorable tumors. It is generally believed that patients who are moderately differentiated to highly differentiated cancer and whose diameter is equal to or less than 4 cm and are not fixed in adjacent tissues are considered to be indications for local treatment. These three indicators can rule out the majority of lymph node metastases.