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既往距肛缘8cm内直肠癌多用Miles术,我所自1978年至1983年,用经腹骶尾切除吻合保留自然肛门方法治疗距肛缘4cm-8cm直肠癌22例,经半年至5年随访除二例年内死亡外,20例均保持正常生活,与同期用Miles,Dixen,Bucon及局部切除病情相似之25例(三年内6例死亡)相比,治疗效果及生活质量均较良好。 手术方法:如常仰卧开腹,游离乙状结肠,切断直肠上动脉,切除系膜及腹膜后淋巴组织,分离直肠至提肛肌平面,缝闭后腹膜及腹壁。改俯卧位,作骰尾切口,自盆腔拉出直肠,于癌缘下不少于2cm切断,以远端直肠与癌变上10cm结肠对端吻合,缝合切口。
The Miles technique was used for rectal cancer within 8cm from the anal margin. From 1978 to 1983, 22 cases of rectal cancer from the anal margin 4cm to 8cm were treated with transabdominal appendectomy and anastomosis to preserve the natural anus. Follow-up from six months to five years was performed. Except for 2 deaths during the year, 20 patients maintained normal life. Compared with the same period of Miles, Dixen, Bucon and 25 cases of local resection (6 deaths within three years), the treatment effect and quality of life were better. Surgical methods: as usual supine laparotomy, free sigmoid colon, cut off the upper rectal artery, the mesentery and retroperitoneal lymph node tissue were removed, the rectum was separated to the levator ani muscle plane, and the posterior peritoneum and abdominal wall were closed. Change the prone position, make an appendix incision, pull the rectum out of the pelvic cavity, cut off at least 2 cm below the cancer margin, and use the distal rectum to align with the cancerous end of the 10 cm colon, and then close the incision.