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目的探讨中低位直肠癌套入式吻合和器械吻合保肛术临床疗效。方法对333例中低位直肠癌根治性切除行套入式吻合保肛术和器械吻合保肛术两组进行回顾性临床分析。套入式吻合保肛术组231例,男137例,女94例,平均59.6岁。Dukes A期79例,B期127例,C期23例,D期2例。低位前切除器械吻合保肛术组102例,男53例,女49例,平均61.4岁。DukesA期23例,B期59例,C期16例,D期4例。333例肿瘤下缘距齿状线6～10 cm。结果 333例术后随访率为84.6%(282/333),中位随访时间为6.7年。套入式吻合保肛术组随访率为85.3%(197/231),术后发生吻合口瘘8例(3.4%),吻合口狭窄3例(1.2%)。前切除器械吻合保肛术组随访率为83.3%(85/102)。术后发生吻合口瘘4例(3.9%),吻合口狭窄2例(1.9%)。两组术后12～24周时排便功能基本恢复到正常,1～3次/d。局部复发率,套入式吻合保肛术组和器械吻合保肛术组分别为5.1%(5/197)和5.8%(5/85),肝转移率为15.2%(30/197)和16.4%(14/85),肺转移率为2.0%(4/197)和2.3%(2/85),术后总体5年生存率为71.6%和69.5%。结论套入式吻合保肛术和低位前切除器械吻合保肛术,既能保留良好的肛门排便功能,提高患者生活质量,其远期局部复发率和5年生存率与Milse手术类似,是目前常采用的保肛术式之一。
Objective To investigate the clinical efficacy of sleeve anastomosis and anastomosis for anastomosis of low and middle rectal cancer. Methods Retrospective clinical analysis of 333 cases of low and middle rectal cancer with radical resection combined with anal sphincter preservation and anal sphincter preservation surgery were retrospectively analyzed. A total of 231 ankle anal sphincterotomy patients were included, including 137 males and 94 females, with an average of 59.6 years. Dukes A 79 cases, B 127 cases, C 23 cases, D 2 cases. Low anterior resection device anus anal operation group of 102 cases, 53 males and 49 females, average 61.4 years. DukesA period in 23 cases, B in 59 cases, C in 16 cases, D in 4 cases. 333 cases of tumor margin from dentate line 6 ~ 10 cm. Results The follow-up rate of 333 cases was 84.6% (282/333). The median follow-up time was 6.7 years. The follow-up rate was 85.3% (197/231) in the anastomosis group, 8 cases (3.4%) were anastomotic fistula and 3 cases (1.2%) were anastomotic stenosis. Preoperative resection anus anal suture group was followed up rate was 83.3% (85/102). Anastomotic fistula occurred in 4 cases (3.9%), anastomotic stenosis in 2 cases (1.9%). At 12 to 24 weeks after operation, the defecation function returned to normal, 1 ~ 3 times / d. The rates of local recurrence were 5.1% (5/197) and 5.8% (5/85) in the anastomosis and anastomosis groups, respectively. The rates of hepatic metastases were 15.2% (30/197) and 16.4 % (14/85). The rates of lung metastases were 2.0% (4/197) and 2.3% (2/85) respectively. The 5-year overall survival rates were 71.6% and 69.5% respectively. Conclusion Anastomosis with anastomosis and anastomosis anastomosis with low anterior resection device can both retain the good anal defecation function and improve the quality of life of patients. The long-term local recurrence rate and 5-year survival rate are similar to Milse’s surgery, One of the most commonly used anal sphincter.