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目的分析在全直肠系膜切除术(TME)基础上采用内括约肌切除(ISR)治疗低位直肠癌的手术经验和初步结果。方法 2000年3月至2007年3月共40例低位直肠肿瘤患者接受 TME基础上的 ISR 治疗。手术方式:腹部手术施行 TME,会阴部手术施行 ISR。术后随访了解并发症、肛门功能、肿瘤局部复发和转移情况。结果本组患者手术均成功完成,无手术死亡。术后随访3个月～7年(平均34个月),39例术后获得较好的肛门功能,Kirwan 分级1～3级。1例发生吻合口瘘,2例发生伤口感染,均经保守治愈。2例术后直肠癌局部复发,其中1例死亡。结论 ISR 治疗超低位直肠癌安全可行,在根治的前提下可良好地保留肛门功能。
Objective To analyze the surgical experience and preliminary results of total mesorectal excision (TME) based on internal sphincterotomy (ISR) for lower rectal cancer. Methods From March 2000 to March 2007, 40 patients with low rectal tumors underwent TME-based ISR. Surgical methods: TME abdomen surgery, perineal surgery ISR. Postoperative follow-up to understand the complications, anal function, local tumor recurrence and metastasis. Results The patients were successfully completed surgery, no operative death. The patients were followed up for 3 months to 7 years (average 34 months). The anal function was obtained in 39 cases and grade 1 to 3 in Kirwan. Anastomotic fistula occurred in 1 case and wound infection occurred in 2 cases, both of which were cured conservatively. Two cases of local recurrence of rectal cancer, including 1 case of death. Conclusion ISR treatment of ultra-low rectal cancer safe and feasible, under the premise of radical preservation of anal function.