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今结合低位直肠癌实施保肛手术94例,就手术适应证及术式选择等问题讨论如下.1 资料和方法1.1 临床病理学资料 1993年8月～1994年12月外科手术治疗低位直肠癌161例,94例实施保肛手术.肿瘤下缘距肛缘:2cm～23例,4cm～38例,6cm～33例.肿瘤肉眼分型:隆起型14例,局限溃疡型56例,浸润溃疡型21例,弥漫浸润型3例.病理分类:高分化腺癌50例,中分化腺癌32例,低分化腺癌5例,粘液腺癌5例,类癌1例.中国改良Dukes分期:A_01例,A_14例,A_2 22例,B23例,C40例,D5例.1.2 低位直肠癌保留肛门括的肌术式选择 结肠—直肠(肛管)吻合口:位于距齿状线3cm以上、腹膜反折以下为低位吻合;在齿状线以上,3cm以内为超低位吻合.结肠和齿状线外科肛管吻合为Parks手术.切除内括约肌、结肠在Hilton线处与肛周皮肤吻合为Bacon手术.
In this study, 94 cases of low rectal cancer are treated with sphincter preserving surgery. Discussions on surgical indications and surgical options are discussed below. 1 Materials and Methods 1.1 Clinical Pathology Data From August 1993 to December 1994, surgical treatment of low rectal cancer 161 Cases, 94 cases of sphincter preserving operation. Tumor margin from the anal edge: 2cm ~ 23 cases, 4cm ~ 38 cases, 6cm ~ 33 cases. Tumor macroscopic type: uplift type in 14 cases, local ulcer type 56 cases, infiltration ulcer type 21 cases, diffuse infiltration in 3 cases. Pathological classification: 50 cases of well-differentiated adenocarcinoma, 32 cases of moderately differentiated adenocarcinoma, 5 cases of poorly differentiated adenocarcinoma, 5 cases of mucinous adenocarcinoma, 1 case of carcinoid. China modified Dukes staging: A_01 Cases, A_14 cases, A_2 22 cases, B23 cases, C40 cases, D5 cases. 1.2 Low rectal cancer retention anus sphincter muscle selection type colon-rectal (anal) anastomosis: located more than 3cm from the dentate line, peritoneal anti Below the fold is a low anastomosis; above the dentate line, an anastomosis is performed within 3 cm. The surgical anal anastomosis of the colon and dentate line is a Parks procedure. The internal sphincter is removed and the colon is anastomosed with the perianal skin at the Hilton line for Bacon surgery.