Schumpelick V, Braun J
Chirurgische Klinik, Medizinischen Fakultät der RWTH Aachen.
Chirurg. 1991 Jan;62(1):25-31.
The long-term clinical and functional results of coloanal anastomosis (CAA) in the management of low and midrectal cancer were analyzed and compared with an age matched group of patients with abdomino-perineal resection (APR). Between 1977 and 1990 85 patients underwent CAA following resection for carcinomas of the mid and low rectum (67 male and 18 female, mean age 57.3 years). In 62 patients the tumor was in the lower and in 23 patients in the middle third of the rectum. A hand-sewn anastomosis was performed in 20 patients, in the 65 most recent patients the anastomosis was performed using a circular stapling instrument. No patient died as a result of pelvic sepsis. Anastomotic leakage occurred in 7% (handsewn 20%, stapled 3%), anastomotic strictures in 2.4%. 9 months after CAA complete or near complete continence was achieved by 85% of the patients. One patient was totally incontinent. More than 3 years postoperatively (1977-1987) 57 patients with curative resection could be analyzed. 39% of the patients had Dukes' A, 31% Dukes' B and 30% Dukes' C lesions. After a mean (+/- SD) length of follow-up of 6.7 years (3-13.6 years) local recurrence cumulative rates were 11% after CAA and 17% after APR, distant recurrence rates were 33% and 34% respectively. According to Dukes' stage the cancer-related 5-years survival of patients after CAA was in Dukes' A stage 88%, in Dukes' B 56%, in Dukes' C 29% and after APR 100, 53, and 22% respectively (p greater than 0.05). From these results we conclude that intersphincteric resection with CAA is a safe and efficient alternative to APR in many distal rectal carcinomas.
分析了结肠肛管吻合术（CAA）治疗中低位直肠癌的长期临床和功能结果，并与年龄匹配的腹会阴联合切除术（APR）患者组进行了比较。1977年至1990年间，85例患者在中低位直肠癌切除术后接受了CAA（67例男性，18例女性，平均年龄57.3岁）。62例患者肿瘤位于直肠下段，23例患者肿瘤位于直肠中段。20例患者采用手工缝合吻合，最近65例患者使用圆形吻合器进行吻合。无患者因盆腔感染死亡。吻合口漏发生率为7%（手工缝合20%，吻合器缝合3%），吻合口狭窄发生率为2.4%。CAA术后9个月，85%的患者实现了完全或接近完全控便。1例患者完全失禁。术后3年以上（1977 - 1987年），对57例根治性切除患者进行了分析。39%的患者为Dukes' A期，31%为Dukes' B期，30%为Dukes' C期。平均（±标准差）随访6.7年（3 - 13.6年）后，CAA术后局部复发累积率为11%，APR术后为17%，远处复发率分别为33%和34%。根据Dukes分期，CAA术后患者的癌症相关5年生存率在Dukes' A期为88%，Dukes' B期为56%，Dukes' C期为29%，APR术后分别为100%、53%和22%（p＞0.05）。从这些结果我们得出结论，对于许多低位直肠癌，括约肌间切除联合CAA是APR的一种安全有效的替代方法。
