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为合理实施直肠癌保肛手术、减少局部复发、提高存活率及生存质量,从中低位直肠癌术后局部复发形式探讨保肛手术的适应证。(1)如何延长病人的生存期是第一重要的原则,而生存质量应属第二位。(2)局部复发的主要形式是由于肿瘤下切端不足、淋巴清扫范围不足及没有按照TME原则进行手术有关。(3)应该在避免以上问题的前提下合理实施保肛手术。其中,肿瘤下缘距离肛门至少5cm以上是最重要的一点,否则无原则的保肛手术不仅不能提高病人的生存质量,而且还能影响生存期限。
In order to rationally implement the anorectal surgery for rectal cancer, reduce local recurrence and improve the survival rate and quality of life, this paper discusses the indications of anorectal surgery from the local recurrence after low and middle rectal cancer. (1) How to prolong the survival of patients is the first important principle, and the quality of life should belong to the second place. (2) The main form of local recurrence is due to insufficient tumor incision, lack of lymphadenectomy, and failure to perform surgery in accordance with TME. (3) should be in the premise of avoiding the above problems under the premise of rational operation of anal sphincter. Among them, the lower edge of the tumor from the anus at least 5cm or more is the most important point, otherwise the principle of anal sphincter preservation can not only improve the quality of life of patients, but also can affect the survival period.