目的 探讨国产单吻合器在低位直肠癌保肛手术中的临床应用效果。方法 结合相关文献回顾性分析2003年1月至2007年12月期间我院收治的128例低位直肠癌中行直肠全系膜切除（TME）且应用国产管状吻合器及荷包钳进行手术的91例患者的资料。结果 全组无手术死亡病例，保肛均获成功，保肛率为71.09%（91/128），术后病理检查肿瘤远端切缘无癌残留。未发生吻合口出血及狭窄； 1例（1.10%）发生吻合口漏，经保守治疗后痊愈； 无大便失禁发生。全组获随访1～5年，平均3.8年，局部复发6例（6.59%）； 总的1年生存率为97.80%（89/91），3年生存率为80.00%（72/90），5年生存率为68.97%（60/87）。结论 TME联合国产管状吻合器及荷包钳应用于低位直肠癌根治术，可提高保肛率，操作简单安全，疗效满意。
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
【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 analyze the relation between preoperative staging and surgical decision-making in rectal cancer patients from the West China Colorectal Cancer Database (DACCA) and to identify key factors influencing the selection of surgical approach. MethodsBased on the updated DACCA dataset as of April 24, 2024, the patients with rectal cancer were included. Chi-square tests and logistic regression analyses were performed to evaluate the correlation between preoperative staging [(y)cTNM stage] and the selection of sphincter-preserving surgery or intersphincteric resection (ISR). Additional factors, including age, body mass index (BMI), tumor location, and nutritional score, were assessed for their impact on surgical choices. ResultsA total of 2 733 rectal cancer patients were included. Preoperative (y)cTNM staging distribution was as follows: 23 (0.8%) at stage 0, 388 (14.2%) at stage Ⅰ, 760 (27.8%) at stage Ⅱ, 873 (31.9%) at stage Ⅲ, and 689 (25.2%) at stage Ⅳ. The preoperative stage Ⅱ–Ⅳ were the independent risk factors for both the choices of sphincter-preserving surgery and ISR [stage Ⅱ: sphincter-preserving surgery: OR(95%CI)=13.634 (4.952, 37.540), P<0.001; ISR: OR (95%CI)=3.097 (2.108, 4.551), P<0.001. stage Ⅲ: sphincter-preserving surgery: OR (95%CI)=14.677 (5.339, 40.345), P<0.001; ISR: OR (95%CI)=2.985 (2.042, 4.363), P<0.001. stage Ⅳ: OR (95%CI)=25.653 (9.320, 70.610), P<0.001; ISR: OR (95%CI)=4.445 (3.015, 6.555), P<0.001]. The low/ultra-low tumor location was an independent risk factor for choice of sphincter-preserving surgery [OR (95%CI)=2.038 (1.489, 2.791), P<0.001], but which was an independent protective factor for the choice of ISR [OR (95%CI)=0.013 (0.009, 0.019), P<0.001]. ConclusionsResults of this study are consistent with clinical practice, indicating that preoperative staging is the core basis for surgical decision-making in rectal cancer. With the progression of staging, patients are more inclined to choose non-sphincter-preserving and non-ISR procedures. Although low/ultralow tumors pose great challenges for anal preservation, the proportion of ISR selection remains relatively high. The anatomical location of the tumor and nutritional status also significantly affect surgical selection, necessitating comprehensive preoperative evaluation.
Objective To compare the outcomes of low/ultra-low anterior rectal resection and valgus resection in elder patients with rectal or anal cancer. Methods The clinical data of 184 patients with rectal or anal cancer， who were treated with extreme sphincter preserving surgery in West China Hospital from January 2009 to December 2011， were collected and analyzed retrospectively. The intraoperative and postoperative indexes between low/ultra-low anterior rectal resection group and valgus resection group were compared. Results ①There were no significant differences in the age，body mass index， gender， diameter of tumor， TNM stage， degree of differentiation， histological type， gross type， and complications before operation， such as hypertension， chronic obstructive pulmonary disease， cardiovascular diseases， diabetes， renal disease， and hypoproteinemia in two groups （P＞0.05）. ②Compared with the low/ultra-low anterior rectal resection group， the distance from the anal verge to the tumor was shorter （P＜0.05） and the distance of distal resec-tion margin of tumor was longer （P＜0.05） in the valgus resection group. ③There were no significant differences in the operation time， blood loss， ASA grade， and the postoperative complications in two groups （P＞0.05）. ④There were no significant differences in the duration of pulling out nasogastric tube， urinary catheter， and drainage tube， the duration of first passing flatus， first defecation， first oral intake， and first ambulation， and hospitalization cost （P＞0.05）. But the postoperative hospital stay and total hospital stay in the valgus resection group were significantly longer than those in the low/ultra-low anterior rectal resection group （P＜0.05）. ⑤All the patients were followed-up for 6-24 months （average 13 months）. During the following-up， only 1 case suffered local tumor recurrence in the valgus resection group. One case suffered distant metastases in the ultra-low anterior rectal resection and valgus resection group， respectively. Eight cases （4.35%） died， of which 4 cases （4.04%） in the low/ultra-low anterior rectal group and 4 cases （4.71%） in the valgus resection group. All the patients were in functional recovery of anal control after operation. Conclusions As the extreme sphincter preserving surgery for elder patients with rectal or anal cancer， the low or ultra-low anterior rectal resection and valgus resection could both be used for elder patients with extreme-low rectal or anal cancer. However， valgus resection results in longer distal surgical margin than that low/ultra-low anterior rectal resection， and it is suitable for the patients with shorter distances from the anal verge to the tumor.