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目的:探讨保肛手术治疗低位直肠癌的临床疗效以及对患者生活质量的影响。方法:将2004年2月—2009年2月收治的低位直肠癌患者40例,按照就诊顺序分为A组与B组,每组20例,A组给予保留肛管括约肌手术治疗,B组采用吻合器技术Dixon前切除术治疗。观察比较两组患者术后正常排便时间及盆腔复发、吻合口复发等局部复发情况。采用自制的生活质量表进行生活质量的评价;随访统计1,3,5年生存率。结果:A组术后恢复正常排便时间为术后(30.1±1.2)d,明显比B组(120.5±1.3)d短(P<0.05),自主排便功能良好;B组吻合口复发3例(15.0%),盆腔复发3例(15.0%),局部复发率为30%;A组1例盆腔复发,无吻合口复发病例,局部复发率为5.0%(P<0.05);A组患者满意度为65.0%明显高于B组,不满意度5%明显低于B组;生活质量评分在41~50分的人数及比例,A组显著高于B组,1,3,5年生存率明显高于B组,以上指标比较均具有统计学意义(P<0.05)。结论:保肛手术治疗低位直肠癌的临床疗效确切,能够明显提高患者的生存率,改善生存质量,不良反应小,前提条件是严格掌握保肛手术的适应证。
Objective: To investigate the clinical effect of anal sphincter preservation surgery on low rectal cancer and its impact on quality of life of patients. Methods: Forty patients with low rectal cancer admitted from February 2004 to February 2009 were divided into group A and group B according to the order of treatment, with 20 cases in each group. Group A received surgical treatment of retained anal sphincter. Group B received Stapler technology Dixon anterior resection treatment. Observe and compare the two groups of patients with normal postoperative defecation and pelvic recurrence, anastomotic recurrence and other local recurrence. The self-made quality of life table was used to evaluate the quality of life. The follow-up statistics were 1, 3 and 5-year survival rates. Results: The normal defecation time of group A was significantly shorter after operation (30.1 ± 1.2) d than that of group B (120.5 ± 1.3) d (P <0.05) The recurrence rate was 5.0% (P <0.05). The patients in group A had a relapse rate of 5.0% (P <0.05) Was significantly higher than 65.0% in group B, and 5% in unsatisfied group was significantly lower than that in group B. The number and proportion of quality of life score in 41 ~ 50 were significantly higher in group A than in group B, and the survival rate was significantly higher in 1, 3 and 5 years Higher than the B group, the above indicators were statistically significant (P <0.05). Conclusion: The anal sphincter preserving surgery is effective in the treatment of low rectal cancer. It can significantly improve the survival rate of patients and improve the quality of life, with less adverse reactions. The prerequisite is strictly for indications of anal sphincter preservation.