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目的分析腹腔镜改良经肛门结肠肛管吻合术(Parks术)治疗低位直肠癌的临床效果。方法低位直肠癌患者86例,采用腹腔镜下改良Parks术切除肿瘤,结肠肛管吻合,评估其术后并发症、肛门控便、排尿以及性功能状况。结果术后出现吻合口漏5例,其中吻合口狭窄3例,全部患者随访24~48个月,肝、肺转移7例,吻合口局部均无复发,复发死亡2例;术后6个月60.2%(50/83)患者对排便情况满意,术后1年73.5%(61/83)患者对排便情况满意;术后2年85.4%(70/82)患者对排便情况满意;术后1个月排尿功能障碍发生率为9.6%(8/83);男性患者术后1个月勃起功能障碍发生率18.0%(9/50),射精功能障碍发生率26.0%(13/50);66.7%(22/33)女性患者术后3个月对性生活满意。结论应用腹腔镜下改良Parks术治疗低位直肠癌安全性高、根治效果好,术后患者可获得较满意的控便、排尿及性功能。
Objective To analyze the clinical effect of laparoscopic modified anorectal colorectal anastomosis (Parks operation) in the treatment of low rectal cancer. Methods Totally 86 patients with low rectal cancer were treated with laparoscopic modified Parks technique to remove the tumor and anastomosis of colon and anal canal. The postoperative complications, anal control, urination and sexual function were evaluated. Results Anastomotic leakage occurred in 5 cases, including 3 cases of anastomotic stenosis. All the patients were followed up for 24-48 months, and hepatic and pulmonary metastases were found in 7 cases. No recurrence occurred in the anastomotic site, and 2 cases died of recurrence. After 6 months 60.2% (50/83) patients were satisfied with defecation, 73.5% (61/83) patients were satisfied with defecation at 1 year after operation, 85.4% (70/82) patients were satisfied with defecation at 2 years after operation, The incidence of urinary dysfunction was 9.6% (8/83) in one month. The incidence of erectile dysfunction in male patients was 18.0% (9/50) and that of ejaculation dysfunction was 26.0% (13/50) in one month after operation; 66.7 % (22/33) Female patients were satisfied with their sexual life 3 months after surgery. Conclusions Laparoscopic modified Parks technique is safe and effective in the treatment of low rectal cancer. Postoperative patients can get satisfactory control of urination, urination and sexual function.