Leo E, Belli F, Andreola S, Baldini M T, Gallino G F, Giovanazzi R, Mascheroni L, Patuzzo R, Vitellaro M, Lavarino C, Bufalino R
Division of General Surgery B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
Ann Surg Oncol. 1996 Jul;3(4):336-43. doi: 10.1007/BF02305662.
There is recent and sporadic evidence indicating that patients with very low rectal cancer may be treated via a sphincter-saving procedure, obviating the need for abdominoperineal resection and definitive colostomy. This study confirms these findings.
From March 1990 to October 1994, 79 patients affected with primary low rectal cancers were submitted for total rectal resection, mesorectum excision, and coloendoanal anastomosis. All lesions were located within 8 cm of the anal verge (within 6 cm in 64 cases).
Eight patients relapsed at the pelvic level, and one patient only at the paraanastomotic site. Postoperative morbidity attributable to the procedure was low. A perfect continence was documented in 66% of cases after colostomy closure, and many patients (63%) had one or two bowel movements a day. Sixty-two patients of this series are alive, 49 without actual evidence of disease. Follow-up ranged from 2 to 56 months (median 23).
The clinical and pathological data derived from this study suggest that radical mesorectum excision more than a large clearance margin of resection remains the most important factor in reducing the incidence of local relapse after low rectal cancer surgery and that total rectal resection and coloendoanal anastomosis is a suitable and safe option to traditional, demolitive surgical techniques.
近期有零星证据表明，极低位直肠癌患者可通过保留括约肌的手术进行治疗，从而无需进行腹会阴联合切除术和永久性结肠造口术。本研究证实了这些发现。
1990年3月至1994年10月，79例原发性低位直肠癌患者接受了全直肠切除、直肠系膜切除和结肠肛管吻合术。所有病变均位于距肛缘8 cm以内（64例位于6 cm以内）。
8例患者盆腔复发，1例仅吻合口旁复发。该手术导致的术后发病率较低。结肠造口关闭后，66%的患者排便控制良好，许多患者（63%）每天排便一至两次。本系列中有62例患者存活，49例无疾病实际证据。随访时间为2至56个月（中位时间23个月）。
本研究得出的临床和病理数据表明，直肠系膜根治性切除而非广泛的切除切缘，仍是降低低位直肠癌手术后局部复发率的最重要因素，全直肠切除和结肠肛管吻合术是传统破坏性手术技术的一种合适且安全的选择。
