摘要
目的介绍一种切除部分齿状线和肛管全层的直肠恶性肿瘤的超低位保肛手术。方法对8例瘤灶下缘距离齿状线小于或等于2cm的直肠超低位恶性肿瘤进行术前评估,对6例患者首先进行术前放疗化疗使肿瘤明显缩小。手术在完成全直肠系膜和(或)盆腔淋巴清扫的基础上,向下切断骶骨直肠韧带,达到肛管直肠肌环上缘,相当于齿状线(直肠肛管交界处)水平。如果癌下缘远侧正常肠管长度仍小于2cm,可沿外括约肌环和肠壁之间再向下分离1～2cm。肛门手术组充分显露肿瘤部位,在直肠癌向下侵犯最低侧所在的1/2象限,于癌灶下缘2cm处垂直于肛管长轴切开肛管全层,然后沿外括约肌环向上游离,切除癌侧部分齿状线,与腹部手术组会师,在没有癌灶或癌侵犯较高的一侧,则沿齿状线上缘切断直肠。游离横结肠脾区并在降结肠远切端作长5cm的“J”形结肠储袋,将结肠储袋向下脱出至肛管断端,与癌灶侧肛管、癌灶对侧的齿状线用3-0可吸收线间断手工缝合。结果在遵守根治原则的基础上,采用本方法成功地为8例直肠超低位恶性肿瘤患者进行了保肛手术,部分切除齿状线的患者术后肛门功能与Dixon手术患者近似。结论在直肠全系膜切除和盆腔淋巴清扫的基础上,尤其在术前放疗化疗的基础上。
Objective To introduce a sphincter saving procedure by partial dentate line and anal wall resection for super low rectal malignancy. Methods Eight patients with malignancy (rectal cancer in 7, malignant stromal tumor in 1)were evaluated preoperatively. Six patients received preoperative chemo radiation(neo adjuvant) therapy and the rectal tumors shrinked effectively. In operation, after total mesorectum resection (with or without pelvic lymph node dissection), the rectum was immobilized down and the puborectal ligament and partial levator ani was cut to the level of dentate line. If the distal rectum was still less than 2 cm, the anus was further immobilized downward between the external spincter and the rectum wall. In anal approach, good exposure was attained and cut line was made more than 2 cm below the malignancy with resection including dentate line immediate down and partial anus wall. The other part of the rectum was excised just above the dentate line. A “J” pouch was constructed in the distal sigmoid and pulled to the anus, and the pouch was anastomosed partially to anus and partially to dentate line with 3 0 absorbable line. Results Eight patients with rectal malignancy were excised radically by partial resection of dentate line and anal wall. The anal function of the patients was similar to those with Dixon operation. Conclusion On the basis of neo adjuvant therapy and total mesorectum resection (or with pelvic lymph node dissection), this sphincter saving procedure by partial dentate line and anal wall resection for super low rectal malignancy can reserve a better functional anus.
出处
《中华胃肠外科杂志》
CAS
2002年第2期107-109,共3页
Chinese Journal of Gastrointestinal Surgery
基金
北京大学985临床多中心前瞻性研究基金资助项目
