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本文报道采用前切除术治疗直肠癌112例,其中手术缝合者53例,应用吻合器者(EEA组)59例。吻合口位于腹膜返折以上者34例,返折以下者78例。五年生存率为63.6％(21/33)。残端有癌者12例,均为手缝组,其中2例再次手术,1例加用~(60)Co治疗,此3例均健在(术后已分别为2、5、16年)。吻合口漏5例(EEA组4例,手缝组1例),吻合口癌肿复发3例(EEA组2例,手缝组1例)。作者认为直肠癌行前切除术不仅取决于肿瘤的部位,还应考虑癌肿大小、浸润范围及手术野的暴露等。吻合器的应用使低位吻合增加了可能性。
This article reports 112 cases of rectal cancer treated with anterior resection, of which 53 cases were surgically sutured and 59 cases were treated with stapler (EEA group). There were 34 cases with anastomosis at or above the peritoneal fold, and 78 cases under the fold. The five-year survival rate was 63.6% (21/33). There were 12 patients with stump cancer, all of which were hand-stitched, of which 2 were reoperative and 1 was treated with ~(60)Co. All 3 patients were alive (postoperatively 2, 5, and 16 years respectively). There were 5 cases of anastomotic leakage (4 cases in EEA group and 1 case in hand-sewn group), and 3 cases of recurrence of anastomotic cancer (2 cases in EEA group and 1 case in hand-sewn group). The authors believe that preoperative resection of rectal cancer depends not only on the location of the tumor, but also the size of the cancer, the extent of infiltration, and the exposure of the surgical field. The use of a stapler increases the likelihood of low alignment.