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目的探讨经肛门内外括约肌间径路切除超低位直肠癌保肛手术的安全可行性,并评价肿瘤根治效果及术后肛门功能。方法分析2000-2004年华中科技大学同济医学院附属协和医院经选择的经肛门内外括约肌间径路切除超低位直肠癌保肛手术病人42例的临床资料。结果腹部手术遵循TME原则,肛门手术在直视下距病灶下缘2cm切断直肠黏膜和肛门内括约肌,经括约肌间隙向上游离达肛管外括约肌环上方与腹部手术会合,近端结肠与肛管完成端端吻合。前瞻性随访术后病人肿瘤复发与肛门排便功能状况。37例病人完成手术,并发症包括发生急性肺栓塞并死亡1例,盆底肌肉出血1例,吻合口漏3例。36例病人获得随访,平均随访时间为40(24~60)个月。3例(8.33%)吻合口复发,其中1例死亡;1例同时肺、腹膜转移于术后24个月死亡;2例因肝转移分别于术后16、24个月死亡;1例腹腔内淋巴结、腹股沟淋巴结转移于术后16个月死亡。术后6个月肛门括约肌功能已比较满意。结论经肛门内外括约肌间径路切除术治疗超低位直肠癌的手术方法是一种可选择的安全性高、根治效果好的保肛术式。
Objective To investigate the safety and feasibility of anus anal sphincter preservation surgery by transanal internal and external sphincterotomy, and evaluate the effect of radical resection of the anus and anal function. Methods The clinical data of 42 patients undergoing anal sphincter preservation surgery after resection of the anus and internal and external sphincter of the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from 2000 to 2004 were analyzed. Results The abdomen operation was performed according to the TME principle. Under direct vision, the rectum mucosa and anus internal sphincter were cut off 2cm away from the lower edge of the lesion under the direct vision. The sphincter muscle was moved up to the upper part of the anal sphincter ring. The proximal colon and the anal canal were completed End anastomosis. Prospective follow - up of patients with tumor recurrence and anal defecation function. Thirty-seven patients underwent surgery. The complications included acute pulmonary embolism and 1 death, 1 pelvic floor muscle hemorrhage, and 3 anastomotic leaks. Thirty-six patients were followed up for an average of 40 (24-60) months. Three patients (8.33%) had anastomotic recurrence, of which 1 died. One patient died of lung and peritoneal metastasis at 24 months after operation. Two patients died of liver metastasis at 16 and 24 months after operation. One patient died of intraperitoneal Lymph node, inguinal lymph node metastasis died after 16 months. Anal sphincter function 6 months after surgery has been more satisfied. Conclusion Surgical treatment of ultralow rectal cancer by intra-anal sphincterotomy is a safe and effective radical anal sphincter.