39例老年低位直肠癌患者保肛根治术体会.docVIP

39例老年低位直肠癌患者保肛根治术体会[摘要] 目的 探讨老年低位直肠癌患者行保肛根治术的临床应用。方法 对2003 年6 月～2008 年12 月间收治的低位直肠癌行保肛术的39 例病人进行回顾性分析。结果 术后发生吻合口瘘2 例,经保守治疗而愈;吻合口癌肿复发5例,均发生在术后8个月～2年,其中属Dukes C期3例,B2期2例。所有患者于2周内均能达到排便自控,其排便功能于术后0.5～1 年恢复正常,大便次数略多于正常,为2～3 次/d。结论 保肛术是治疗中、下段直肠癌的一种合理术式,根治效果与排便功能令人满意。 [关键词] 老年; 直肠癌; 保肛术 [中图分类号] R735.3 [文献标识码] A [文章编号] 1673-9701(2009)23-151-02 Experience of Low Rectal Cancer Radical Operation Anus in 39 Cases of Elderly Patients Li Ming Lang1 Liu Xin2 1.The Special Hospital of Zhoukou of Henan Province,Henan 466000;2.The People’s Hospital of Dancheng of Henan Province,Henan 477150,China [Abstract] ObjectiveTo explore the clinical applicatione of radical mastectomy for elderly patients with low rectal cancer anus. Methods From June 2003 to December 2008,39 patients with low rectal cancer were retrospectively analyzed. ResultsPostoperative anastomotic leakage occurred in 2 cases,they were treated with the more conservative treatment. Anastomotic recurrence of cancer cases occurred in 5 patients after 2 months to 8 years. Three cases of them are affiliated to Duke’sc period. All patients in the 2 weeks of self-control can reach the bowel,the bowel function in 0.5 ~ 1 year after return to normal,slightly more than the normal frequency of stool for 2 or 3 times/d. ConclusionTreatment with sphincter-saving surgery are the middle and lower rectal cancer surgery are reasonable,radical bowel function and satisfactory results. [Key Words]Elderly; Cancer; Anus surgery 近年来,全直肠系膜切除术(TME)在临床上的成功应用,使低位直肠癌的保肛率明显提高,局部复发率显著下降。我院自2003 年6 月～2008 年12 月收治低位直肠癌行保肛术的病人39例,现就其临床特点及外科诊治分析如下。 1 资料与方法 1.1 一般资料 本院行保肛术39例,男23例,女16例;年龄57～71岁,平均年龄67岁,癌肿下缘距肛缘8cm 以下的下段直肠癌22 例,8～12cm 的中段直肠癌17 例。自发病到确诊时间为15d～2年。Dukes 分期:A期3 例(7.7%),B期17例(43.6%),C期15例(38.5%),D期4例(10.3%)。病理类型:腺癌29例,管状腺癌4例,黏液腺癌4例,息肉癌变2例。 1.2 方法 Dixon前切除术32例,Bacon拖出术2例,Parks结肠肛管吻合术2例,经腹骶直肠癌切除术2例,经肛门局部切除术1例。 2 结果 术后并发症:发生吻合口瘘2 例,其中1例发生于Dixon’s 吻合术后,1例发生于拖出式吻合口术后,经保守治疗而愈;吻合口癌肿复发5 例,均发生在术后8 个月～2 年,其中属Duk