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目的探讨经腹肛门内括约肌切除保肛术治疗超低位直肠癌的临床疗效。方法选取2005年5月至2012年9月间收治的88例T1期和T2期超低位直肠癌患者实施经腹肛门内括约肌切除保肛术,术后随访观察患者术后3个月、6个月及12个月的肛门括约肌功能并进行Kirwan分级,观察患者术后局部复发率、肛门括约肌功能和5年生存率。结果 88例患者术后随访观察1~8年不等,平均随访时间4.3年,其中随访5年以上者36例,术后发生吻合口瘘3例(3.4%),吻合口狭窄4例(4.5%),发生应激性溃疡1例(1.1%)。随术后评估时间的延长,患者肛门括约肌功能逐渐改善,Kirwan分级水平不断减低;术后中位生存时间为80个月,5年生存率为75.0%。结论经腹肛门内括约肌切除保肛术是超低位直肠癌较理想、安全的术式,术后根治效果良好,肛门括约肌功能较满意。
Objective To investigate the clinical effect of trans-anal sphincter preservation and anal sphincter preservation in treatment of ultra-low rectal cancer. Methods Eighty-eight patients with T1 and T2 rectal cancer who underwent transanal anus sphincterotomy were selected from May 2005 to September 2012 for anal sphincter preservation. The patients were followed up for 3 months and 6 months after operation Month and 12 months anal sphincter function and Kirwan grading, observation of local recurrence rate, anal sphincter function and 5-year survival rate. Results The follow-up of 88 patients ranged from 1 to 8 years with an average follow-up time of 4.3 years. Among them, 36 cases were followed up for 5 years or more, 3 cases (3.4%) had anastomotic fistula, 4 cases (4.5 cases) %), Stress ulcer occurred in 1 case (1.1%). The anal sphincter function gradually improved and Kirwan grade decreased with the extension of postoperative evaluation time. The median postoperative survival time was 80 months and the 5-year survival rate was 75.0%. Conclusions Transrectal anal sphincter resection is an ideal and safe operation for ultra-low rectal cancer. The postoperative cure is good and the anal sphincter function is satisfactory.