Han Shao-liang, Shen Xian, Zeng Qi-Qiang, Guo Sheng-chong, Cheng Jun, Zhu Guan-bao
Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province, China.
J Gastrointest Cancer. 2010 Sep;41(3):159-64. doi: 10.1007/s12029-010-9131-6.
The purpose of this study was to evaluate the outcome and genitourinary complications of super-low anterior resection (SLAR) followed by adjuvant radiochemotherapy in the management of patients with low rectal cancer.
One hundred and six low rectal cancer patients managed with SLAR were analyzed retrospectively.
There were seven patients who failed to follow up, and the 5-year survival rate was 65.7% (65/99). There were 35 patients (35.4%) who developed distant metastases, and 12 (12.1%) had local recurrence. The local recurrence rates were 21.1% (4/19), 7.1% (2/28), 5.9% (1/17), and 0% (0/2) in the patients with tumor distance of less than or equal to 2 cm, ranging from 2.1 to 3.0, from 3.1 to 4.0, from 4.1 to 5.0, and more than 5 cm, respectively. This implied local recurrence rate increased against the distance between the lower margin of tumor and resection line. Ninety-eight of 106 rectal patients had complete data of questionnaire: 58 scored 1, 32 scored 2, 7 scored 3, and 1 score 4. This revealed that the fecal function of most patients (91.8%, 90/98) was normal or nearly normal. Twenty-four of 37 males suffered from sexual dysfunction, and among them, eight were impotent (all older than 70 years), and 29 had retrograde ejaculation. Meanwhile, seven of 35 females suffered from sexual problem, 1 had dyspareunia, seven had decreased lubrication, and one had inability to achieve orgasm.
SLAR followed by adjuvant radiochemotherapy can effectively control local-regional disease and can be one choice of avoiding the functional morbidity of abdominoperineal resection.
本研究旨在评估超低位前切除术（SLAR）联合辅助放化疗治疗低位直肠癌患者的疗效及泌尿生殖系统并发症。
回顾性分析106例接受SLAR治疗的低位直肠癌患者。
7例患者失访，5年生存率为65.7%（65/99）。35例患者（35.4%）发生远处转移，12例（12.1%）出现局部复发。肿瘤下缘距切除线小于或等于2 cm、2.1至3.0 cm、3.1至4.0 cm、4.1至5.0 cm及大于5 cm的患者局部复发率分别为21.1%（4/19）、7.1%（2/28）、5.9%（1/17）和0%（0/2）。这表明局部复发率随肿瘤下缘与切除线之间的距离增加而升高。106例直肠癌患者中有98例有完整的问卷调查数据：58例评分为1分，32例评分为2分，7例评分为3分，1例评分为4分。这表明大多数患者（91.8%，90/98）的排便功能正常或接近正常。37例男性中有24例出现性功能障碍，其中8例阳痿（均大于70岁），29例逆行射精。同时，35例女性中有7例出现性问题，1例性交困难，7例润滑减少，1例无法达到性高潮。
SLAR联合辅助放化疗可有效控制局部区域疾病，是避免腹会阴切除术功能障碍的一种选择。
