摘要
目的分析低位直肠癌根治手术保肛率的影响因素。方法将316例行根治手术的低位直肠癌(肿瘤下缘距齿状线在1cm以上、5cm以下)患者按不同的时间段分成前期组和后期组:前期组有89例,为1994年8月至1998年12月收治者;后期组227例,为1999年1月至2005年11月收治的,此组患者均行规范的全直肠系膜切除术。同时,按手术方式分为腹会阴联合根治术(APR)组(103例)和保肛手术(SP)组(213例)。分别比较分析两组患者的临床病理资料。结果行APR的患者比例逐年减少(前期组55.1%,后期组23.8%),而行SP的患者从前期的44.9%上升到后期的76.2%(P=0.000)。SP和APR两组比较,肿瘤下缘距齿状线距离、性别、不同时期、肿瘤周径和分化程度的差异有统计学意义(P<0.05);而年龄、大体分型、Dukes分期差异无统计学意义(P>0.05)。前期与后期两组比较,性别、术中输血量、Dukes分期差异有统计学意义(P<0.05);而年龄、肿瘤下缘距齿状线距离和手术时间差异无统计学意义(P>0.05)。前期组行LAR的患者发生吻合口瘘的比率为2.7%(1/37例),后期组为1.3%(2/160例),差异无统计学意义(P>0.05)。结论全直肠系膜切除术在一定程度上提高了低位直肠癌的保肛率,且明显减少了术中输血量,并未延长手术时间,也未增加吻合口瘘的发生率。
Objective To analyze the factors related to sphincter preserving（SP） operation for lower rectal cancer. Methods Clinicopathological data of 316 patients with lower rectal cancer 1 - 5 cm from the anorectal line who underwent surgical resection from Aug. 1994 to Nov. 2005 were analyzed. The whole period was divided into two period based on the introduction of TME in Jan. 1999. The SP rates, leakage between the two period were compared. Results The SP rate increased significantly from 44. 9% in period I （Aug. 1994 - Dec. 1998） to 76. 2% in period Ⅱ （Jan. 1999 - Nov. 2005） （ P = 0. 000） . The factors significantly influencing SP were the distance from the anorectal line, sex, period, circumference of intramural spread, histological differentiation（ P 〈 0. 05 ）. Significant differences were detected between the two period in sex, volume of blood transfusion, Dukes＇ stage（ P 〈 0. 05） . The rate of leakage were 2.7% and 1.3% in the two period（ P 〉 0. 05）. Conclusions Over 12 years the SP rate of rectal cancers 1 - 5 cm from the anorectal line was significantly increased and volume of blood transfusion reduced obviously due to the introduction of TME. These surgical techniques, however, have no effect on the operating time and leakage rates.
出处
《中华胃肠外科杂志》
CAS
2006年第2期107-110,共4页
Chinese Journal of Gastrointestinal Surgery
