论文部分内容阅读
本文总结了我院1980年至1997年直肠癌保肛手术1059例经验,并对各种保肛手术适应证选择、优缺点进行讨论和评价。 资料和方法 本组病例共1059例。(1)局部切除139例,其中粘膜下层(SM)癌56例,固有肌层(MP)癌69例,转移癌(M1)14例,经肛切除124例,经骶切除15例,均为高、中分化直肠中下段癌。肿瘤直径<4cm,周径<1/3,活动良好。(2)前切除791例,其中高位前切除(返折上)288例,低位(腹膜返折下)和超低位(距齿线3cm内)前切除503例,均为距肛缘5cm以上高、中分化腺癌,肿瘤活动好,体型偏瘦。(3)拖出吻合术129例,均为肿瘤下缘距肛缘4cm以上高、中分化腺癌,活动好,体型肥胖。局部切除方法是距肿瘤1cm以上全层盘状切除,横形缝合。前切除和拖出吻合术必须切除肿瘤下缘3～5cm以上距离。拖出吻合术是将肿瘤切除,远段直肠翻出肛门外,保留1cm以上直肠与拖出肛门外的近段结肠行全层一期吻合后再返纳回盆腔。术后补加放疗4000rad。
This article summarizes the experience of 1059 cases of sphincter preserving surgery for rectal cancer in our hospital from 1980 to 1997, and discusses and evaluates the options, advantages and disadvantages of various sphincter preserving procedures. Data and Methods A total of 1059 cases of this group of cases. (1) Local excision was performed in 139 cases, including 56 submucosal (SM) carcinomas, 69 muscularis propria (MP) carcinomas, 14 metastatic carcinomas (M1), 124 anal resections, and 15 orbital resections. High and moderately differentiated rectal mid-lower cancer. Tumor diameter <4cm, circumference <1/3, good activity. (2) Anterior excision of 791 cases, including 288 cases with high anterior resection (retrograde), 503 cases with low resection (under peritoneal reflex) and ultralow position (within 3 cm from the dentate line), all 5 cm above anal margin In moderately differentiated adenocarcinoma, the tumor activity is good and the body is thin. (3) 129 anastomoses were pulled out, all of which were high and medium-differentiated adenocarcinomas with a distance of more than 4 cm from the anal margin of the tumor, and had good activity and body fatness. The local resection method was a full-thickness disk-like resection and transverse suture at a distance of 1 cm from the tumor. The anterior resection and dragging anastomosis must remove the tumor from the lower edge of 3 ~ 5cm or more. Pull out the anastomosis is to remove the tumor, distal rectum out of the anus, retain more than 1cm above the rectum and drag the anus out of the proximal colon line after a full-phase one-stage anastomosis and then return to the pelvic cavity. Postoperative radiotherapy supplement 4000rad.