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目的探讨低位直肠癌保肛术的安全性和对肿瘤的根治性。方法回顾性分析2003年1月至2008年6月于我科应用吻合器行根治性保肛手术的78例低位直肠癌患者的临床资料,手术遵循直肠癌根治切除术和直肠系膜全切除术的原则,远近切缘距肛瘤分别至少达2.5cm及10cm,应用双吻合器法于骶前行结直肠端端吻合。结果 78例患者均一期行吻合,无手术死亡。术后56例患者出现肛门刺激症状,予对症治疗8～12个月,症状均有明显改善。2例患者出现吻合口瘘,分别予保守及手术治疗后治愈。2例患者出现排尿功能障碍,2例患者出现性功能障碍,予对症治疗后均有缓解,各有1例患者出现脂肪液化及伤口感染,予加强伤口换药护理后愈合。吻合口狭窄1例,于门诊定期扩肛后缓解。所有患者术后均行folfox4方案辅助化疗,术后成功随访72例患者,吻合口复发1例,盆腔复发3例,其中并发肺转移1例,复发转移率为5.56。结论应用双吻合器法进行低位直肠癌的保肛手术是安全有效的,同时可保证肿瘤的根治性和较好的保留患者的排便、排尿及性功能。
Objective To investigate the safety of anal sphincter preservation in low rectal cancer and its curative effect on tumor. Methods The clinical data of 78 patients with low rectal cancer who underwent radical anorectal surgery from January 2003 to June 2008 in our department were retrospectively analyzed. The patients underwent radical resection of rectal cancer and total mesorectal excision Principle, near and far margins from the anal tumor were at least 2.5cm and 10cm, the application of double stapling method in presacral colorectal end anastomosis. Results All the 78 patients were anastomosed in the first trimester without any operative death. 56 cases of postoperative anal irritation, to symptomatic treatment of 8 to 12 months, the symptoms were significantly improved. Two patients had anastomotic fistula, were conservative and surgical treatment were cured. Two patients had voiding dysfunction, two patients had sexual dysfunction, and were relieved after symptomatic treatment. One patient had fatty liquefaction and wound infection, which healed after wound replacement. Anastomotic stenosis in 1 case, at the clinic rectal rectal relief. All patients underwent postoperative folfox4 regimen adjuvant chemotherapy, 72 patients were followed up successfully, anastomotic recurrence in 1 case, pelvic recurrence in 3 cases, of which 1 case of pulmonary metastasis, the recurrence and metastasis rate was 5.56. Conclusions The double stapling method is safe and effective for anal sphincter preservation of low rectal cancer. At the same time, it can guarantee the radicalness of the tumor and keep the defecation, urination and sexual function of the patients well.