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目的探讨套入式结肠直肠黏膜吻合保肛术治疗中低位直肠癌的可行性和安全性及临床疗效。方法对231例中低位直肠癌经腹肛门根治性切除行套入式结肠直肠黏膜吻合保肛术进行回顾性分析。结果 231例术后随访率为85.3%(197/231),中位随访时间为5.9年(2个月～14年)。术后发生吻合口瘘8例(3.4%),吻合口狭窄3例(1.2%),术后12～24周时排便功能基本恢复正常。术后局部复发率为5.1%(10/197),肝转移率为15.2%(30/197)。肺转移率为2.5%(5/197),术后5年总体生存率为71.6%。结论套入式吻合保肛术既能减少吻合口瘘发生,又可保留良好的肛门排便控制功能,可显著提高患者术后生活质量,是中低位直肠癌一种安全有效的保肛术式。
Objective To investigate the feasibility, safety and clinical efficacy of sleeve-in colorectal mucosa anastomosis for the treatment of low and middle rectal cancer. Methods Retrospective analysis of 231 cases of rectal cancer with low and middle rectal carcinoma undergoing radical anrectotomy with colorectal mucosa anastomosis. Results The follow-up rate of 231 patients was 85.3% (197/231). The median follow-up time was 5.9 years (ranged from 2 months to 14 years). Postoperative anastomotic fistula occurred in 8 cases (3.4%), anastomotic stenosis in 3 cases (1.2%), 12 to 24 weeks after the defecation function returned to normal. The local recurrence rate was 5.1% (10/197) and the hepatic metastasis rate was 15.2% (30/197). The lung metastasis rate was 2.5% (5/197) and the 5-year overall survival rate was 71.6%. Conclusion Nesting anal sphincter preservation can reduce the incidence of anastomotic fistula, but also retain good anal defecation control function, which can significantly improve the quality of life of patients. It is a safe and effective anal sphincter for low and middle rectal cancer.