Zuo Zhi-gui, Song Hua-yu, Xu Chang, Li Ji, Ni Shi-chang, Chen Shao-qi
The Colorectal Surgery Department of the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Zhonghua Wai Ke Za Zhi. 2009 Jul 1;47(13):988-91.
To study the combination of trans-anal intersphincteric resection and transabdominal total mesorectal excision for anus-retained ultra-low rectal tumors.
Clinical data of 34 ultra-low rectal tumor patients without external anal sphincter involved, who underwent the combination surgery, were retrospectively analyzed.
The distance from the distal incisal margin of the rectum to the inferior margin of the tumor ranged from 1.8 cm to 3.0 cm on an average of 2.1 cm. For pathological types, there were 23 cases of adenocarcinoma (9 well differentiated and 14 moderately differentiated), 1 papillary carcinoma, 2 rectal stromal tumor, 5 rectal villous adenoma with neoplasia and 3 giant villous adenoma. For pathological stages, there were 18 cases at stage pTNM I, 5 at IIA, 1 at IIB, 4 at IIIA, 1 at III and for T grading, there were 15 cases at stage T1, 5 at T2, 8 at T3, 1 at T4. In these 34 patients, there were 3 cases with postoperative anastomotic stenosis, 2 with postoperative anastomotic rupture, 2 with rectovaginal fistula and no operative death. Because of the dysfunction of bowel control, bowel frequency varied from 3 to 12 in the early stage after operation, but with the recovery of anus function, bowel frequency decreased and ranged form 1 to 5 times a day and the time of formed bowel control could be more than 5 min in 6-12 months after operation. However, patients underwent total resection of internal anal sphincter still suffered from incontinence of loose stool after 1 year. After operation, anastomotic recurrence was found in 1 case in 5 months, liver metastasis in 1 case in 10 months and 28 months respectively, cardiac sudden death in 1 case in 26 months.
The combination of trans-anal ISR and trans-abdominal TME for anus-retained ultra low rectal tumor is not only coincident with radical tumor principle but also retains the function of anus, on the premise of the strict indication.
探讨经肛门括约肌间切除术与经腹全直肠系膜切除术联合应用于保肛超低位直肠癌手术的效果。
回顾性分析34例未累及外括约肌的超低位直肠癌患者行联合手术的临床资料。
直肠远端切缘距肿瘤下缘距离为1.8～3.0 cm，平均2.1 cm。病理类型：腺癌23例（高分化9例，中分化14例），乳头状癌1例，直肠间质瘤2例，直肠绒毛状腺瘤伴瘤变5例，巨大绒毛状腺瘤3例。病理分期：pTNM Ⅰ期18例，ⅡA期5例，ⅡB期1例，ⅢA期4例，Ⅲ期1例；T分期：T1期15例，T2期5例，T3期8例，T4期1例。34例患者中，术后吻合口狭窄3例，吻合口破裂2例，直肠阴道瘘2例，无手术死亡。术后早期因控便功能障碍，排便次数3～12次/d，随着肛门功能恢复，排便次数减少至1～5次/d，术后6～12个月能形成成形大便且控便时间＞5 min。但行内括约肌完全切除者术后1年仍有稀便失禁。术后5个月吻合口复发1例，10个月、28个月分别出现肝转移1例，26个月心源性猝死1例。
经肛门括约肌间切除术与经腹全直肠系膜切除术联合应用于保肛超低位直肠癌手术，在严格掌握适应证的前提下，既符合肿瘤根治原则，又能保留肛门功能。
