TME联合ISR不同术式治疗T1和T2期超低位直肠癌的临床疗效观察

摘要

Objective To evaluate the clinical effect and postoperative anal function of total mesorectum excision (TME) combined with different intersphincteric resection (ISR) surgery in the treatment of T1 and T2 stage ultra-low rectal cancer patients. Methods The clinical data of 68 cases of T1 and T2 stage ultra-low colorectal cancer patients who received the TME combined with different ISR surgeries from January 2010 - January 2014 were retrospectively analyzed, in which there were 22 cases of complete internal anal sphincter excision (complete ISR), and 26 cases of partial internal anal sphincter excision, and the remaining 20 cases were administered with ISR + dentate line preser-vation. Results 1) The operation time, intraoperative blood loss, length of removed intestinal canal, distance of surgi-cal margin, the number of resected lymph nodes, negativity of surgical margin, and postoperative complications of the three groups were compared, and no statistically significant differences were observed (P > 0.05); 2) In 3, 6, 12 months after surgery, there were more patients with normal anal function in the partial ISR group and the dentate line preservation group than in the completely ISR group (χ2 = 4.384, 4.227, 4.654, P = 0.026, 0.018, 0.015, respective-ly). Conclusion TME combined with ISR surgery is safe and effective in the treatment of T1 and T2 stage ultra-low rectal cancer, and it is clinically important to improve postoperative anal function that the radical resection is guaran-teed while partial internal anal sphincter and dentate line are preserved as much as possible.%目的：探讨全直肠系膜切除术（TME）联合经肛门括约肌间切除术（ISR）不同术式治疗T1和T2期超低位直肠癌的肿瘤根治效果及术后肛门功能观察。方法回顾性分析68例实施TME联合ISR手术的T1和T2期超低位直肠癌患者的临床资料，其中实施切除全部内括约肌的ISR者22例作为完全ISR组，切除部分内括约肌的ISR者26例作为部分ISR组，保留部分齿状线的ISR者20例作为保齿ISR组。比较三组患者的手术情况及术后肛门功能恢复情况。结果①三组的手术时间、术中出血量、切除肠管长度、远切缘距离、清扫淋巴结数目、切缘阴性情况及术后并发症发生情况比较差异无统计学意义（P>0.05）；②术后3、6、12个月时，部分ISR组和保齿ISR组的肛门功能良好率优于完全ISR组（χ2分别为4.384、4.227、4.654，P分别为0.026、0.018、0.015）。结论 TME联合ISR治疗T1和T2期超低位直肠癌安全有效，在保证根治性的前提下尽可能地保留部分内括约肌和齿状线对改善术后肛门功能具有重要的临床意义。