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目的探讨保肛术式和Milse术式治疗直肠癌的临床疗效。方法回顾性分析1980年1月至2006年572例直肠癌手术,其中施行各种保肛术式403例和Milse术式169例。对患者术后并发症、复发率、转移率和五年生存率等进行比分析。结果随访时间为0.5～25年,中位随访时间为9.5年,随访率为76.2%(436/572)。术后总的局部复发率为6.7%(29/436),各种保留肛门术式为6.3%(20/317),其中套入式结肠直肠黏膜吻合保肛术为4.9%(9/182),Dixon手术为7.2%(4/55),改良Bacon术为11.1%(1/9),前切除吻合器吻合术为8.4%(6/71),Miles手术为7.6%(9/119),差异无统计学意义(x~2=1.3942,P>0.05),显示出术后局部复发率略有下降可能与近年来重视直肠全系膜切除有关。术后总的远处转移率为15.8%(69/436)。各种保留肛门术式为15.7%(50/317),Miles手术为16.2%(19/119),差异无统计学意义(x~2=0.6672,P>0.05)。术后总体5年生存率为67.6%(295/436),其中Miles手术为68.3%(80/119),保留肛门手术为67.8%(215/317)。其中套入式结肠直肠黏膜吻合保肛术为72.5%(132/182)。比较术后五年生存率套入式吻合保肛术略有提高,但差异无统计学意义(x~2=0.6672,P>0.05)。表明了与近10年来TME手术开展,以及综合治疗手段得到了加强有关。结论直肠癌保肛术后局部复发率和五年生存率与Miles手术基本相同,但患者生活质量得到明显提高。直肠癌术式确定应根据病变部位、生物学特性,临床分期、进行个体化选择。
Objective To investigate the clinical efficacy of anal sphincter preservation and Milse procedure in the treatment of rectal cancer. Methods Retrospective analysis of 572 rectal cancer surgeries performed between January 1980 and 2006 included 403 cases of anal sphincter preservation and 169 cases of Milse operation. The postoperative complications, recurrence rate, metastasis rate and five-year survival rate were analyzed. Results The follow-up time ranged from 0.5 to 25 years. The median follow-up time was 9.5 years. The follow-up rate was 76.2% (436/572). The total local recurrence rate after operation was 6.7% (29/436), and the various preserved anus procedures were 6.3% (20/317), of which 4.9% (9/182) were for colorectal anastomosis, 7.2% (4/55) in Dixon surgery, 11.1% (1/9) in modified Bacon surgery, 8.4% (6/71) in anterior stapler anastomosis, and 7.6% in Miles surgery (9/119) The difference was not statistically significant (x ~ 2 = 1.3942, P> 0.05), showing a slight decrease in the local recurrence rate may be related to the emphasis on rectal total mesorectal excision in recent years. The total postoperative distant metastasis rate was 15.8% (69/436). There were 15.7% (50/317) cases of retained anal surgery and 16.2% (19/119) of Miles surgery, the difference was not statistically significant (x 2 = 0.6672, P> 0.05). The overall postoperative 5-year survival rate was 67.6% (295/436), of which Miles was 68.3% (80/119) and anus was 67.8% (215/317). Including colorectal mucosal anastomosis anorectal surgery was 72.5% (132/182). The survival rate of five-year postoperative intussusception anastomosis was slightly improved, but the difference was not statistically significant (x ~ 2 = 0.6672, P> 0.05). It shows that with the TME surgery in the past 10 years, and the comprehensive treatment has been strengthened. Conclusion The local recurrence rate and five-year survival rate of rectal cancer after anus-preserving operation are basically the same as those of Miles operation, but the quality of life of patients with rectal cancer is significantly improved. Rectal cancer surgery should be based on the location of the lesion, biological characteristics, clinical stage, individual choice.