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目的 探讨直肠中下段癌保留肛门括约肌功能最佳治疗术式。方法 对采用经腹经肛门切除中下段直肠癌又经肛门行结肠直肠粘膜吻合术 32例。癌灶下缘距肛缘 6～ 7cm 2 0例 ,8～10cm 12例。结果 全组无手术死亡 ,无吻合口瘘和吻合口狭窄发生。术后随访 32例 6～ 5 2个月 ,平均 2 9个月。于术后 19个月局部癌复发 1例 (3 1% ) ,现仍无癌生存 31例。本组术后 8～ 12周时排便功能控制良好 ,为 1～ 3次 /d ,18周时肛门排便功能基本恢复正常 ,排便次数为 1～ 2次 /d。结论 在合理选择手术适应证的前提下 ,结肠直肠粘膜吻合术可作为手术治疗低位直肠癌并保留肛门的一种安全术式。
Objective To explore the best treatment for the preservation of the anal sphincter in rectal cancer. Methods Thirty-two cases of rectal cancer were treated with transanal resection of middle and lower rectal cancer and transanal mucosal anastomosis. The margin of the tumor margin was 6 to 7 cm 2 in the anal margin, and 8 to 10 cm in 12 cases. Results No operative death occurred in the whole group, no anastomotic leakage and anastomotic stenosis occurred. Postoperative follow-up 32 cases 6 to 52 months, an average of 29 months. At 19 months after surgery, 1 case (3 1%) of cancer recurred, and there were still 31 cases of cancer survival. The defecation function was well controlled from 8 to 12 weeks after operation in this group, which was 1 to 3 times per day. At 18 weeks, the function of the anus defecation basically returned to normal, and the frequency of defecation was 1 to 2 times per day. Conclusions Under the premise of reasonable selection of surgical indications, colorectal mucosal anastomosis can be used as a safe surgical treatment for low rectal cancer and retain the anus.