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目的为探讨直肠中下段癌保留肛门临床最佳治疗术式。方法对1993年～1997年收治28例中下段直肠癌经腹肛门切除后经肛门行结肠直肠粘膜吻合术。结果随访6～52个月,平均29个月。无手术死亡率,无吻合口漏和吻合口狭窄发生。仅1例于术后19个月局部癌复发(3.6%),余27例现仍无瘤生存。术后8～12周时排便控制良好,次数为2～3次/日,18周时肛门排便功能基本恢复正常,排便次数为1～2次/日。结论合理选择手术适应症,既要避免腹壁结肠造口,又要保证手术的彻底性,在提高患者生活质量的同时,还要注重远期效果。
Objective To explore the best clinical treatment of anorectal cancer in the middle and lower rectum. Methods From 1993 to 1997, 28 cases of middle and lower rectal cancer were treated with transanal rectal anastomosis and transanal mucosal anastomosis. The results were followed up for 6 to 52 months with an average of 29 months. No operative mortality, no anastomotic leakage, and anastomotic stenosis occurred. Only 1 case had local recurrence (3.6%) at 19 months after surgery, and the remaining 27 cases were still tumor-free. The bowel movements were well controlled from 8 to 12 weeks after operation, and the frequency was 2 to 3 times per day. At 18 weeks, the anus defecation function returned to normal, and the frequency of defecation was 1 to 2 times per day. Conclusion Reasonable choice of surgical indications not only avoids colostomy of the abdominal wall, but also guarantees the thoroughness of the operation. At the same time improving the quality of life of patients, we must pay attention to the long-term effect.