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目的探讨低位直肠癌经骶尾、腹腔直肠切除术的临床应用效果。方法回顾性分析大连医科大学附属第一医院2002年1月至2008年1月期间收治的低位直肠癌(T3-T4)行根治性切除415例病人临床资料,成功随访376例,其中Miles手术172例,经骶尾、腹腔直肠切除术(SAR)204例,比较术后复发率、5年存活率,评价SAR的临床效果。结果 Miles组手术时间平均(3.61±1.43)h,SAR组(3.03±1.08)h。Miles组术中出血量(213.34±83.32)mL,SAR组(74±51.08)mL(P<0.001),明显少于Miles手术组。Miles组术后复发率为20.3%,SAR组为4.9%(P=0.01)。Miles组5年存活率为48.3%,SAR组为60.3%,P=0.009。多因素分析显示手术体位、浸润深度、淋巴结转移、分期、环周切缘是独立的影响因子。结论 SAR虽然术中要变换体位,但手术时间、出血量均低于Miles手术组。局部复发率、5年存活率SAR组均优于Miles组,SAR对于低位直肠癌是有效的治疗方法。
Objective To investigate the clinical effect of sacrococcygeal and abdominal rectal resection for low rectal cancer. Methods The clinical data of 415 patients undergoing radical resection of low rectal cancer (T3-T4) admitted to the First Affiliated Hospital of Dalian Medical University from January 2002 to January 2008 were retrospectively analyzed. Among them, 376 patients were followed up successfully, including Miles Surgery 172 Cases, the sacrococcygeal, abdominal resection (SAR) 204 cases, compared the recurrence rate, 5-year survival rate, evaluate the clinical effect of SAR. Results The mean operative time in Miles group was (3.61 ± 1.43) h and that in SAR group (3.03 ± 1.08) h. The intraoperative blood loss (213.34 ± 83.32) mL in Miles group and 74 ± 51.08 mL (P <0.001) in SAR group were significantly less than those in Miles operation group. The Miles recurrence rate was 20.3% in the SAR group and 4.9% in the SAR group (P = 0.01). The 5-year survival rate was 48.3% in the Miles group and 60.3% in the SAR group, P = 0.009. Multivariate analysis showed that operation position, depth of invasion, lymph node metastasis, staging and circumferential margin were independent influential factors. Conclusion Although the surgery should change the position of SAR, the operation time and bleeding amount are lower than those of Miles operation group. The local recurrence rate and 5-year survival rate in SAR group were better than those in Miles group. SAR was an effective treatment for low rectal cancer.