论文部分内容阅读
目的探讨Miles手术和保肛术治疗直肠癌的临床疗效。方法1984年1月至2004年12月20年间,共收治618例直肠癌患者,对其行Miles手术和保肛术式治疗。其中1984年1月至1993年12月前10年中,收治患者273例,行Miles术136例,各种保肛手术137例。1994年1月至2004年12月后10年中,收治患者345例,行Miles手术102例,各种保肛手术243例。对前后10年患者的术后并发症,复发与转移情况,术后生存率进行总结、分析。结果术后共有492例患者进行随访,时间1个月～20年,平均5年,随访率为79.6%。前10年术后局部复发率为6.9%,其中Miles术为6.7%,各种保肛术为7.1%。后10年术后局部复发率为5.1%,其中Miles术为4.8%,各种保肛术为5.2%,其中套入式结肠直肠黏膜吻合保肛术为4.9%。前10年术后5年总体生存率为64.7%,其中Miles手术为66.3%,保留肛门手术为63.4%。后10年术后5年总体生存率为68.0%,其中Miles手术为66.3%,保留肛门手术为68.7%,其中套入式结肠直肠粘膜吻合保肛术为71.3%。结论直肠癌术式应根据病变部位、生物学特性、临床分期、个体化进行选择,近10年来保肛手术逐渐增多,约占70%,保肛术后5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,套入式结肠直肠黏膜吻合保肛术是一种安全有效的术式。
Objective To investigate the clinical effects of Miles surgery and anal sphincter preservation in rectal cancer. Methods From January 1984 to December 2004, 618 patients with rectal cancer were admitted to Miles surgery and anal sphincter treatment. Among them, from January 1984 to December 1993 in the first 10 years, 273 patients were treated, 136 patients underwent Miles operation, and all kinds of anal sphincter preservation surgery in 137 cases. From January 1994 to December 2004, 345 cases were treated, 102 cases underwent Miles operation and 243 kinds of anal sphincter preservation surgery. After 10 years of patients with postoperative complications, recurrence and metastasis, postoperative survival rate were summarized and analyzed. Results A total of 492 patients were followed up for 1 month to 20 years with an average of 5 years. The follow-up rate was 79.6%. The first 10 years postoperative local recurrence rate was 6.9%, of which Miles surgery was 6.7%, a variety of anal surgery was 7.1%. After 10 years, the local recurrence rate was 5.1%, of which Miles surgery was 4.8%, various anal sphincter preservation surgery was 5.2%, of which 4 cases were intussusception of colorectal mucosal anastomosis. The overall 5-year survival rate after the first 10 years was 64.7%, of which Miles was 66.3% and anus was 63.4%. The overall 5-year survival rate was 68.0% at 5 years after surgery. The Miles operation was 66.3% and the anorectal surgery was 68.7%. The intussusception of colorectal mucosa was 71.3%. Conclusion Rectal cancer surgery should be based on the location of the lesion, biological characteristics, clinical stage, individualized selection, anal surgery in the past 10 years gradually increased, accounting for about 70%, 5-year survival rate after anus-anal surgery and Miles surgery are basically the same, However, the quality of life of patients has been significantly improved, set of colorectal mucosa anus anal sorectomy is a safe and effective operation.