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目的评价经肛门内外括约肌间切除直肠的超低位直肠癌保肛手术的临床疗效。方法总结31例低位直肠癌患者直肠全系膜切除术(TME)加经肛门内外括约肌间切除术的临床资料。结果31例患者肿瘤下缘距齿状线2cm以内,有18例进展期直肠癌患者术前先进行放、化疗。腹部手术施行全直肠系膜切除,向下切断骶骨直肠韧带和部分肛提肌达肛门外括约肌环上缘,沿外括约肌环和肠壁(内括约肌)之间再向下分离1～2cm。肛门手术组在癌灶下缘2cm之齿状线下方垂直于肛管长轴切开内括约肌全层,然后沿肛门内、外括约肌环间隙向上游离,与腹部手术组会师。将近端结肠或结肠储袋与肛管或肛管-齿状线行端端吻合。全组无手术死亡;术后肛门功能恢复较好。平均随访12个月,29例患者无复发和转移;1例出现复发和转移,另1例癌胚抗原19.9,但未发现转移灶。结论经肛门内外括约肌间切除直肠的超低位直肠癌保肛手术可以达到良好的根治性,并保留较好的肛门功能,是一种可选择的根治性保肛手术方法。
Objective To evaluate the clinical effect of anal sphincter preserving surgery in transrectal resection of the rectum between the anus and the internal sphincter. Methods The clinical data of 31 patients with low rectal cancer undergoing total mesorectal excision (TME) plus transanal internal and external sphincterotomy were summarized. Results The lower edge of the tumor in 31 patients was less than 2 cm from the dentate line, and 18 patients with advanced rectal cancer were treated with radiotherapy and chemotherapy before operation. Total mesorectal excision of the abdominal surgery, cut down the sacral rectum ligament and part of the levator ani external anal sphincter ring edge, along the outer sphincter ring and intestinal wall (internal sphincter) and then separated down 1 ~ 2cm. The anus surgically operated the full length of the internal sphincter perpendicular to the longitudinal axis of the anal canal below the dentate line 2 cm below the margin of the lesion and then moved upward along the internal and external sphincter annuli and interacted with the abdominal surgery group. The proximal colon or colon pocket and the anal canal or anal canal - dentate line end of the line anastomosis. The whole group died without surgery; anal function recovered better. With a mean follow-up of 12 months, 29 patients had no recurrence and metastasis, 1 had recurrence and metastasis, and 1 had 19.9 CEA, but no metastases were found. Conclusions Anal sphincter preservation surgery can achieve a good radical curettage and maintain good anal function. It is an alternative radical anal sphincter preservation method.