【摘要】目的 探讨低位直肠癌保肛手术的术式选择及其治疗效果。方法 回顾性分析我院1997年7月至2002年7月期间行低位直肠癌保肛手术治疗的90例患者的临床资料。结果 行低位直肠癌保肛手术者占同期的66.2%(90/136)。90例中距肛缘5 cm以内者14例，5~8 cm者76例； 行Dixon术84例，经肛门局部切除术4例，Parks术2例。术后发生吻合口漏8例，其中Dixon术7例，Parks术 1例； 肛门狭窄2例，其中Dixon术1例，Parks术 1例； 无手术死亡。90例患者术后均获随访,64例随访23~59个月，中位随访时间为39个月，其中Dixon术59例，Parks术2例，局部切除术3例。局部复发6例，其中Dixon术5例，局部切除术1例。 结论 Dixon术是低位直肠癌保肛手术的主要术式； 在严格掌握适应证的情况下，可考虑施行低位直肠癌的局部切除术。
ObjectiveTo explain the latest concepts of colorectal surgery, and predict the future direction of it. MethodsA review and summary based on the clinical experience of our hospitals and theses over the past years and new advances on the researches in home and abroad were performed. ResultsDoctors should attach more importance to anal preserving operation; and there should be more usage of fast track in colorectal surgery. Besides, predicting low risk of postoperative complications and digitizing colorectal surgery also needed more attention. ConclusionThose aspects of colorectal surgery in the result need further development.
Objective To compare the long-term outcomes between laparoscopic and open sphinter preservation operation for low rectal cancer. Method The literatures about the long-term outcomes between laparoscopic and open sphinter preservation operation for low rectal cancer were reviewed. Result Compared with open sphinter preservation operation, laparoscopic sphincter preservation operation for low rectal cancer did not increase locoreginonal recurrence rate and metasatasis rate. Conclusion The safety, efficacy, and long-term outcomes remain to be determined by more randomized clinical tirals and evidence-based medical results.
Objective To investigate the safety and feasibility of the total mesorectal excision （TME） and intersphincteric resection （ISR） for ultra-low rectal cancer and anal sphincter preservation surgery for anorectal cancer， and to evaluate the short term efficacy and postoperative anal function. Methods A retrospective analysis of clinical and follow-up data of 86 cases with TME＋ISR for ultra-low rectal cancer and anorectal cancer from January 2009 to December 2010 in West China Hospital of Sichuan University were performed. Results Eighty-six patients were successfully performed the operation， the lower edge of tumor from the anus was 1-5 cm （average 1.63cm）； tumor diameter was 2-7 cm （average 3.4cm）. The tumors were high differentiation in 4 cases， moderately differentiation in 60 cases，and poorly differentiation in 22 cases. The pTNM stages were stageⅠin 12 cases， stageⅡA in 11 cases， stage ⅡB in 15 cases， stage ⅢA in 2 cases， stage ⅢB in 23 cases， stage ⅢC in 16 cases， and stage Ⅳ in 7 cases. There were postoperative anastomotic leakage in 3 cases， perianal infection in 2 cases （1 case received reoperation with permanent colostomy because of pelvic peritoneal infection caused by perianal severe infections）. Anastomotic bleeding and anastomotic stenosis were of 2 cases respectively. Rectovaginal fistula， inflammatory ileus， urinary retention， and abdominal infection were of 1 case respectively. Eighty-six patients were followed-up for 12-24 months， the mean time was 18 months. Liver metastases was found in 1 case in 7 months after operation， 2 cases dead in the 7th month and 12th month after operation respectively. Local recurrence were found in 3 cases （3.5%） in 1 year after operation. The survival rate of 1-year was 97.7% （84/86）. The times of defecation was 1-5 times a day. The Kirwan’s score level on function of control defecation was 1-2 grade. Conclusions TME＋ISR for low rectal cancer and anorectal cancer is a viable， safe， and radical operation type for preservation of anus. The short term efficacy is satisfactory.