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目的探讨经腹结肠肛管吻合术治疗低位直肠癌的临床应用价值。方法回顾性分析2001年11月至2005年12月,北京大学第一医院普外科收治的36例距肛缘4~6cm的低位直肠癌采用双吻合技术行直肠及部分外科肛管全层切除(部分内括约肌切除),经腹结肠肛管吻合术的资料。结果吻合口距肛缘平均2.5cm。中位随访时间23个月,术后远处转移4例,无局部复发者。3年总存活率100%,无瘤存活率84.6%。术后1年,随访28例病人,根据Williams分级标准,肛门控便功能Ⅰ级(完全自制)23例,Ⅱ级(排气失禁)2例,Ⅲ级(偶尔漏稀便)3例。结论经腹结肠肛管吻合术是治疗距肛缘4~6cm低位直肠癌的较理想保肛术式;切除部分内括约肌对肛门的远期功能无明显影响。
Objective To investigate the clinical value of transabdominal colon anastomosis in the treatment of low rectal cancer. Methods Retrospective analysis from November 2001 to December 2005, Peking University First Hospital, Department of Surgery, 36 cases from the anal verge 4 ~ 6cm of low rectal cancer with double anastomosis rectum and partial surgical resection of the anal canal full-thickness resection Part of the sphincter resection), transabdominal anal canal anastomosis data. Results Anastomotic anal verge average 2.5cm. The median follow-up time was 23 months, distant metastasis in 4 cases, no local recurrence. 3-year total survival rate of 100%, tumor-free survival rate of 84.6%. One year after the operation, 28 patients were followed up. According to Williams grading criteria, there were 23 cases of grade Ⅰ (completely self-made) with anal control and defecation function, 2 cases of grade Ⅱ (exhaust incontinence) and 3 cases of grade Ⅲ (occasionally loose stool). Conclusion Transabdominal anal canal anastomosis is an ideal anal sphincter for the treatment of low rectal cancer of 4 ~ 6cm from the anal verge. Excision of the internal sphincter has no significant effect on the long-term anal function.