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目的探讨在女性低位直肠癌患者中行后盆腔清除术时兼行保肛手术的可能性。方法自 195 4年 1月至 1999年 12月共收治女性直肠癌 10 2 7例 ,其中 718例为低位直肠癌 ,能行根治性切除者 5 70例 ,占 79 4% ,行后盆腔清除术者 2 73例占 47 9%。按不同时期分二组 ,Ⅰ组 195 4～ 1989年 ,低位直肠癌 36 6例 ,行后盆腔清除术者 2 0 6例 ,占 5 6 3% ,其中 2 2例行后盆腔清除低位前切除 (后盆腔次全切除 ,简称次全切除组 ) ,占 10 7%。Ⅱ组 1990～ 1999年 ,低位直肠癌 2 0 4例 ,行后盆腔清除术 6 7例 ,占 32 8% ,其中 2 6例行次全切除 ,占 38 8%。二组病例在病理学类型、组织学分类和病理分期上均无差异。结果总手术死亡率 3 3% ,二组之间无差异 ,分别为 3 4%和 3 0 %。 48例行清扫保肛手术者发生吻合口漏 4例 (8 3% ) ,均发生于Ⅰ组 ,故Ⅰ组吻合口漏发生率高达 18 2 %。全组术后局部复发 13例 ,占 4 8% ,其中Ⅰ组复发 9例 (4 4% ) ,Ⅱ组 4例 (6 0 % ) ,P >0 0 5。 13例均复发于盆腔 ,无吻合口复发。Ⅰ组 5年生存率 (5 3 2± 1 9) % ,Ⅱ组 (6 7 3± 1 6 ) % ,P <0 0 5。结论女性低位直肠癌患者在行后盆腔清除时 ,对合适的病例兼行保肛手术不但可行 ,而且不会增加局部复发率。Ⅱ组 5年生存率的提高则是我们?
Objective To investigate the possibility of concurrent anal sphincter preservation in postoperative pelvic laparoscopic surgery in women with low rectal cancer. Methods A total of 10 277 cases of female rectal cancer were treated from January 1994 to December 1999, of which 718 were low rectal cancer. There were 5 70 cases with radical resection, accounting for 79.4%. Postoperative pelvic dissection 2 73 cases accounted for 47 9%. Group Ⅰ was divided into two groups according to different periods. Group Ⅰ was 366 cases of low rectal cancer from 195 4 to 1989. There were 206 cases of pelvic cavity resection after operation, accounting for 56.3%. Among them, 2 cases were performed anterior pelvic removal (Subtotal pelvic resection, referred to as subtotal resection group), accounting for 107%. Group Ⅱ from 1990 to 1999, low rectal cancer 204 cases, after pelvic removal 67 cases, accounting for 32.8%, of which 26 cases subtotal subtotal, 388%. There was no difference between the two groups in pathological type, histological classification and pathological staging. Results The total operative mortality was 33%. There was no difference between the two groups, which was 34% and 30% respectively. In 48 cases, anastomotic leak happened in 4 cases (83%), all occurred in group Ⅰ, so the incidence of anastomotic leakage in group Ⅰ was as high as 18 2%. Thirteen cases (48%) had local recurrence after operation, of which 9 cases (4 4%) in group Ⅰ and 4 cases (60%) in group Ⅱ, P> 0.05. Thirteen patients relapsed in the pelvis, no anastomotic recurrence. The 5-year survival rate of group Ⅰ was (53.2 ± 1.9)%, that of group Ⅱ (67.3 ± 16)%, P <0.05. Conclusion In women with low rectal cancer after pelvic clearance, the appropriate cases of anal sphincter preservation surgery is not only feasible, but will not increase the local recurrence rate. Ⅱ group 5-year survival rate increase is us?