Objective To study application of laparoscopic total mesorectal excision (TME) combined with in-tersphincteric resection (ISR) in clinical treatment of non-external urethral sphincter invasive ultra-low rectal carcinoma and to evaluate therapeutic effect and impact on anal function of patients. Methods Retrospective analysis was con-ducted on clinical data of 30 patients with non-external urethral sphincter invasive ultra-low rectal carcinoma treated in our hospital from April 2012 to April 2014. All patients were treated with TME combined with ISR. Patients were record-ed for operative indicators such as operative time, bleeding volume, the number of lymph nodes dissected excision, as well as hospitalization indicators such as gastrointestinal function recovery and length of hospital stay. The Wexner score was adopted to evaluate the anal function before treatment, at 1 month and 6 months after treatment, and anal function was classified according to KIRWAN. After 36-month follow-up, all patients were observed for occurrence of complica-tions and relapse as well as transfer. Results Among the 30 patients, there were 17 cases with partial resection of inter-nal anal sphincter, 8 cases with sub-total resection of internal anal sphincter, and 5 cases with total resection of internal anal sphincter. All these patients had successful operation without anyone being transferred to laparotomy. There was no anal stenosis, ileus, and other complications among all patients. There were 5 cases with relapse with a mean relapse time of (3.76±1.03) months, 1 case with liver metastasis with mean operative time of (232.54±53.43) min, mean intraop-erative bleeding volume of (102.32±22.43) mL, mean hospital stay of (8.54±1.45) days, mean recovery time of gastroin-testinal motility of (24.43±5.43) hours, mean gastrointestinal decompression of (37.54±7.43) hours, mean lymph node ex-tirpation of (10.87±2.21) pieces, and dentate line of (1.65±0.43) cm. All patients had successful anus preservation opera-tion with a success rate of 100％. Anal Wexner score before operation was higher than that at 1 month and 6 months after operation, with difference having statistical significance (P<0.01). Anal function KIRWAN classification included 20 cas-es of level Ⅰ, 6 cases of level Ⅱ and 4 cases of level Ⅲ. Conclusion TME combined with ISR has obvious effect on clinical treatment of non-external urethral sphincter invasive ultra-low rectal carcinoma, which can distinctly optimize anal function with good prognosis quality and high operative safety, being free of complications after operation.%目的 探究腹腔镜全系膜切除术(TME)联合经肛内括约肌切除保肛术(ISR)在非外括约肌侵犯性超低位直肠癌临床治疗中的应用效果.方法 回顾性分析2012年4月至2014年4月期间30例在东莞市第三人民医院进行手术治疗的非外括约肌侵犯性超低位直肠癌患者的病历资料,所有患者均行TME联合ISR治疗.详细记录患者手术时间、出血量、淋巴结清扫数等手术指标以及胃肠功能恢复、住院时间等住院指标;对治疗前、治疗1个月、6个月肛门功能采用Wexner评分进行评价,并进行肛门功能KIRWAN分级;经过为期36个月的跟踪随访,观察所有患者并发症、复发及转移情况.结果 30例患者中内括约肌部分切除17例,内括约肌次全切除8例,内括约肌全切除5例,均顺利完成手术,无转开腹手术者;所有患者无肛门狭窄、肠梗阻等并发症,5例复发,复发时间平均(3.76±1.03)个月,1例出现肝脏转移;手术时间平均(232.54±53.43)min;术中出血量平均(102.32±22.43)mL;住院时间平均(8.54±1.45)d;恢复胃肠蠕动时间平均(24.43±5.43)h;胃肠减压时间平均(37.54±7.43)h;淋巴结摘除平均(10.87±2.21)枚;吻合口距齿状线(1.65±0.43)cm;所有患者均保肛成功,保肛成功率为100％;术前肛门Wexner评分显著高于术后1个月、6个月,差异具有显著统计学意义(P<0.01);肛门功能KIRWAN分级:Ⅰ级20例、Ⅱ级6例、Ⅲ级4例.结论 TME联合ISR在非外括约肌侵犯性超低位直肠癌临床治疗中疗效确切,其能够显著改善肛门功能,预后质量良好,术后无并发症,手术安全性较高.
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