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极低位直肠癌的括约肌间切除术:最新文献综述

Intersphincteric resection for very low rectal cancer: A review of the updated literature.

作者信息

Shirouzu Kazuo, Murakami Naotaka, Akagi Yoshito

机构信息

Department of Gastrointestinal Surgery Japan Community Health care Organization Kurume General Hospital Kurume Japan.

Department of Surgery Kurume University Faculty of Medicine Kurume Japan.

出版信息

Ann Gastroenterol Surg. 2017 Apr 25;1(1):24-32. doi: 10.1002/ags3.12003. eCollection 2017 Apr.

Abstract

Intersphincteric resection (ISR) has rapidly increased worldwide including laparoscopic surgery. However, there are some concerns for the definition of ISR, surgical technique, oncological outcome, anal function, and quality of life (QoL). The aim of the present study is to evaluate those issues. A review of this surgical technique was carried out by searching English language literature of the PubMed online database and appropriate articles were identified. With regard to open-ISR, the morbidity rate ranged from 7.5% to 38.3%, with lower mortality rates. Local recurrence rates varied widely from 0% to 22.7%, with a mean follow-up duration of 40-94 months. Disease-free and overall 5-year survival rates were 68-86% and 76-97%, respectively. Those outcomes were equivalent to laparoscopic-ISR. Surgical and oncological outcomes of ISR were generally acceptable. However, accurate evaluation of anal function and QoL was difficult because of a lack of standard assessment of various patient-related factors. The surgical and oncological outcomes after ISR seem to be acceptable. The ISR technique seems to be valid as an alternative to abdominoperineal resection in selected patients with a very low rectal cancer. However, both necessity for ISR and expectations of QoL impairment as a result of functional disorder should be fully discussed with patients before surgery.

摘要

包括腹腔镜手术在内,括约肌间切除术(ISR)在全球范围内迅速增加。然而,对于ISR的定义、手术技术、肿瘤学结果、肛门功能和生活质量(QoL)存在一些担忧。本研究的目的是评估这些问题。通过检索PubMed在线数据库中的英文文献对该手术技术进行了综述,并确定了合适的文章。关于开放ISR,发病率在7.5%至38.3%之间,死亡率较低。局部复发率差异很大,从0%到22.7%不等,平均随访时间为40 - 94个月。无病生存率和5年总生存率分别为68 - 86%和76 - 97%。这些结果与腹腔镜ISR相当。ISR的手术和肿瘤学结果总体上是可以接受的。然而,由于缺乏对各种患者相关因素的标准评估,难以准确评估肛门功能和生活质量。ISR术后的手术和肿瘤学结果似乎是可以接受的。对于某些低位直肠癌患者,ISR技术似乎是腹会阴联合切除术的有效替代方法。然而,在手术前应与患者充分讨论ISR的必要性以及因功能障碍导致生活质量受损的预期。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4191/5881339/8411e2fdfa51/AGS3-1-24-g001.jpg

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