论文部分内容阅读
本文对我院建院以来施行腹膜返折以下直肠癌保肛手术分析结果表明,病灶位于腹膜反折以下直肠癌患者的生存率及复发率并没有因为保肛而受到影响。结合我院的其它研究提出肿瘤远端切除的充分与否是选择保肛手术的前题,其下切端长度应综合肿瘤的病理类型,浸润周径及Dukos分期考虑。本组病例Duke C期病人的5年与10年生存率分别为32.1％、7.7％,证明进行淋巴清扫及侧方清扫,可使一部分Dudes C期病人获得5年甚至10年的生存,从而强调了扩大根治在保肛手术中的重要性,提出保肛手术的原则及适应症:保肛手术必须清除足够的淋巴结;切除足够的远端肠管;切除足够的侧方组织;注意保护肠管的血运,建立通畅的双腔引流,在此基础上根据肿瘤的部位选择不同的保肛手术:肿瘤下界距肛缘7cm行前切除术6cm行Turbull—Catoif手术,5cm行Block Bacon或改良Poiks手术。改良Parks手术远端肠管切除充分,肛门功能良好,为腹膜返折以下直肠癌拉出术中较好的手术。
This article analyzes the results of sphincter preserving anal operation performed after peritoneal recanalization has been performed since our hospital was established. It shows that the survival rate and recurrence rate of rectal cancer patients whose lesions are located below peritoneal refraction are not affected by the preservation of the anus. Combining with other studies in our hospital, it is proposed that the fullness of the distal resection of the tumor is the precondition of selecting an anus-preserving operation. The length of the lower end of the tumor should be combined with the pathological type of the tumor, infiltration circumference and Dukos stage. The 5-year and 10-year survival rates of patients in this group of patients were 32.1% and 7.7%, respectively, demonstrating that lymph node dissection and lateral dissection resulted in a partial survival of Dudes C patients for 5 years or even 10 years. To expand the importance of radical sphincter preservation surgery, the principle and indications of sphincter preserving surgery are suggested: sufficient lymph nodes must be removed during sphincterotomy; sufficient distal intestine should be removed; sufficient lateral tissue should be removed; and the blood of intestinal tract should be protected The operation was carried out to establish a smooth double-lumen drainage. Based on this, different sphincter preserving operations were selected according to the location of the tumor: the lower margin of the tumor was 7cm along the anal margin and 6cm was performed with Turbull-Catoif surgery, and 5cm with Block Bacon or modified Poiks. The modified Parks procedure had adequate distal resection of the bowel, good anal function, and better resection of rectal cancer following peritoneal resection.