Ultralow anterior resection with intersphincteric dissection--what is the limit of safe sphincter preservation?
Ultralow anterior resection with intersphincteric dissection--what is the limit of safe sphincter preservation?
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DOI：
10.1046/j.1463-1318.2003.00508.x
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发表时间：
2003-09-01
期刊：
影响因子：
--
通讯作者：
Parc, R
中科院分区：
文献类型：
--
作者：
Tiret, E;Poupardin, B;Parc, R
简介：在低位直肠癌的治疗中，部分括约肌切除增加了保留括约肌手术的可能性，这可能使一些传统上通过腹-会阴切除治疗的患者获得肿瘤安全的切除边缘。本研究的目的是评估括约肌间切除术的发病率、死亡率以及肿瘤和功能结果，以确定该技术是否可以被认为是一种安全的保护括约肌的方法。方法：1992年5月至1999年12月，26例直肠腺癌患者（平均55岁，28-82岁）经腹入路结肠j袋肛管吻合术行部分括约肌切除术。肿瘤距肛门边缘平均距离4.25 cm（范围3.1 ~ 5.25），T1 4例，T2 (3n +) 14例，T3 (3n +) 7例，T4 (N+) 1例。10例患者采用新辅助放疗。一名患者的远端切除边缘呈阳性，随后进行了安全的腹会阴切除（APR）。其余患者固定标本的远端切除边缘平均为1.6厘米（范围0.3-3.5）厘米。结果：无死亡病例。发病率为30%，吻合口漏率为11%。平均随访39个月（11 ~ 93个月），局部复发率3.4%。在平均27（8-66）个月的随访中，对25例患者的功能结果进行了评估：65%的患者每24小时排便0-2次，31%的患者每24小时排便3-5次，4%的患者每24小时排便6 - 9次。夜间排便9例（36%）。50%的患者尿失禁正常，23%的患者报告尿失禁，27%的患者报告轻微的尿失禁。没有人出现严重的尿失禁，85%的人认为结果令人满意。结论：本研究支持当前文献的观点，即对于某些选定的低位直肠肿瘤，部分括约肌切除术是一种肿瘤学上和功能上安全的选择，而不是腹会阴切除术。
INTRODUCTION: In the treatment of low rectal cancer, the possibility of sphincter preserving surgery is increased by partial sphincteric resection which may allow an oncologically safe resection margin in some patients who would traditionally have been treated by abdominoperineal resection. The aim of this study is to evaluate the morbidity, mortality and the oncological and functional results of intersphincteric resection to determine whether the technique may be considered a safe means of sphincter preservation.METHODS: Between May 1992 and December 1999, 26 patients (mean age 55 years, range 28-82) with adenocarcinoma of the rectum had partial sphincteric resection by an abdominal approach with a colonic J-pouch anal anastomosis. The mean distance between the tumour and the anal verge 4.25 (range 3.1-5.25) cm. Four tumours were T1, 14 T2 (3 N+), 7 T3 (3 N+), and 1 T4 (N+). Neoadjuvant radiotherapy was used in 10 patients. The distal resection margin was positive in one patient who then proceeded to safe abdominoperineal resection (APR). In the remaining patient the mean distal resection margin on the fixed specimen was 1.6 (range 0.3-3.5) cm.RESULTS: There were no deaths. Morbidity was 30% with an anastomotic leak rate of 11%. At mean follow-up of 39 (range 11-93) months the local recurrence rate was 3.4%. Functional results were evaluated in 25 patients at mean follow-up of 27 (8-66) months: 65% had 0-2 bowel motions per 24 h, 31% had 3-5 and 4% between 6 and 9. Nine patients (36%) had nocturnal defecation. Continence was normal in 50% with 23% reporting incontinence to gas and 27% reporting minor episodes of incontinence. None had major incontinence and 85% considered their outcome satisfactory.CONCLUSION: This study supports the current literature indicating that partial sphincteric resection is an oncologically and functionally safe alternative to abdominoperineal resection for some selected low rectal tumours.