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目的 为使低位直肠癌手术切除范围更合理 ,降低术后局部复发率 ,减少因人工肛门所造成的痛苦。方法 对 14 7例低位直肠癌外科手术进行回顾性分析。行各种方式的保肛手术 79例 ,行Mile′s手术 68例。Duke′s分期 :A期 17例 ,B期 72例 ,C期 5 8例。结果 本组无瘤生存 3年以上 93例占 72 .1% ;五年以上 71例占 63 .4%。术后局部复发 42例占 2 8.9%。其中盆腔内复发 2 7例占 64 .3 % ( 2 7/42 ) ,坐骨直肠窝内复发 5例占 11.9% ( 5 /42 ) ,吻合口复发 4例占 9.5 % ( 4 /42 )。局部复发与肿瘤病理类型及Duke′s分期有关 ,而与手术方式无关。结论 对低位直肠癌肿瘤分化程度高 ,Duke′s分期为B期、C期患者应适当扩大手术切除范围。对于肿瘤下缘距齿状线 3～ 4cm以上的低位直肠癌应尽可能争取行保肛手术并强调适当扩大盆腔内清扫范围是降低低位直肠癌手术后局部复发的关键
Objective To make the scope of surgical resection of lower rectal cancer more reasonable, reduce the local recurrence rate, and reduce the pain caused by artificial anus. Methods A retrospective analysis of 147 low rectal cancers was performed. All manner of sphincter preserving operations were performed in 79 cases and Mile’s operation was performed in 68 cases. Duke’s staging: 17 cases in stage A, 72 cases in stage B, and 58 cases in stage C. Results In this group, tumor-free survival was more than 3 years and 93 cases accounted for 72.1%; 71 cases accounted for 63.4% over 5 years. Local recurrence in 42 cases accounted for 28.9%. Among them, 2 7 cases of intrapelvic recurrence accounted for 64. 3% (27/42), 5 cases of recurrence of rectal rectal fossa accounted for 11.9% (5/42), and 4 cases of anastomotic recurrence accounted for 9.5% (4/42). Local recurrence was associated with tumor pathology and Duke’s staging, but not with the surgical approach. Conclusions The high degree of differentiation of low rectal cancer, Duke’s stage B, C stage patients should be appropriately expanded surgical resection. For the low rectal cancer with the dentate line from 3 to 4cm below the tumor, the anal operation should be avoided as much as possible, and the emphasis on appropriate enlargement of the pelvic dissection range is the key to reduce local recurrence after low rectal cancer surgery.