目的 探讨CT仿真内镜（CT virtual endoscopy，CTVE）在低位直肠癌术前分期中的价值。方法 收集我院2008年8月1日至2011年3月1日期间的直肠癌患者57例，术前行直肠CTVE检查，详细记录患者直肠癌周围组织浸润和淋巴结转移的情况；患者术后常规进行病理检查，比较两者结果的差异。结果 术前直肠CTVE检查与术后石蜡病理检查对直肠癌周围淋巴结转移的判断经四格表χ2检验，差异无统计学意义（χ2=2.5，P＞0.05），其对直肠癌周围淋巴结转移预测的敏感性为66.67%，特异性为93.94%。术前直肠CTVE预测直肠癌周围组织浸润和术后病理检查结果经四格表χ2检验，差异有统计学意义（χ2=4.4，P＜0.05），其对直肠癌周围组织浸润判断的敏感性为27.78%，特异性为42.86%。结论 CTVE在术前评估直肠癌周围淋巴结转移有较高的可信性，但对直肠癌周围组织浸润的评价较差。
Objective To investigate the safety and feasibility of the total mesorectal excision （TME） and intersphincteric resection （ISR） for ultra-low rectal cancer and anal sphincter preservation surgery for anorectal cancer， and to evaluate the short term efficacy and postoperative anal function. Methods A retrospective analysis of clinical and follow-up data of 86 cases with TME＋ISR for ultra-low rectal cancer and anorectal cancer from January 2009 to December 2010 in West China Hospital of Sichuan University were performed. Results Eighty-six patients were successfully performed the operation， the lower edge of tumor from the anus was 1-5 cm （average 1.63cm）； tumor diameter was 2-7 cm （average 3.4cm）. The tumors were high differentiation in 4 cases， moderately differentiation in 60 cases，and poorly differentiation in 22 cases. The pTNM stages were stageⅠin 12 cases， stageⅡA in 11 cases， stage ⅡB in 15 cases， stage ⅢA in 2 cases， stage ⅢB in 23 cases， stage ⅢC in 16 cases， and stage Ⅳ in 7 cases. There were postoperative anastomotic leakage in 3 cases， perianal infection in 2 cases （1 case received reoperation with permanent colostomy because of pelvic peritoneal infection caused by perianal severe infections）. Anastomotic bleeding and anastomotic stenosis were of 2 cases respectively. Rectovaginal fistula， inflammatory ileus， urinary retention， and abdominal infection were of 1 case respectively. Eighty-six patients were followed-up for 12-24 months， the mean time was 18 months. Liver metastases was found in 1 case in 7 months after operation， 2 cases dead in the 7th month and 12th month after operation respectively. Local recurrence were found in 3 cases （3.5%） in 1 year after operation. The survival rate of 1-year was 97.7% （84/86）. The times of defecation was 1-5 times a day. The Kirwan’s score level on function of control defecation was 1-2 grade. Conclusions TME＋ISR for low rectal cancer and anorectal cancer is a viable， safe， and radical operation type for preservation of anus. The short term efficacy is satisfactory.
目的 探讨肛管拖出式双吻合器在超低位直肠癌保肛手术中的应用价值。方法 回顾性总结我院23例超低位直肠癌保肛手术的经验。结果 本组病例利用肛管拖出和双吻合器技术行超低位保肛术均获成功，术后发生吻合口漏1例（4.3%），切口感染2例（8.7%），术后局部复发2例（8.7%），无手术死亡。结论 肛管拖出式双吻合器技术行超低位保肛术是安全可靠的，它可以大大提高超低位直肠癌保肛手术的成功率。
Objective To summarize the assessment methods of anal function after low/ultralow rectal anastomosis in patients with rectal cancer. Methods Domestic and international publications on the study of evaluation of anal function after low/ultralow rectal anastomosis in patients with rectal cancer were collected and reviewed. Results Anal function of patients with rectal cancer was usually evaluated by feeling of discharge, continence, perceptual function of rectum, defecate frequency, and defecation time, anal manometry and three-dimensional vector manometry were used as well. Recovery of anal function in patients with rectal cancer after low/ultralow rectal anastomosis depended on the integrity of anal canal, length of remaining rectum, level of anastomosis, and integrity of mucosa. Conclusions Subjective assessment methods and auxiliary measuring instruments are the common means to evaluate the rectal-anal function. Subjective assessment method is simple and direct, but its accuracy is low; Auxiliary measuring instruments have high accuracy, while their examination costs are high and that of costs are not popular, the new assessment methods are needed for further research.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
Objective To evaluate the effects of neoadjuvant long-course chemoradiotherapy (CRT), neoadjuvant short-course radiotherapy (SCRT), and total neoadjuvant treatment (TNT) on chemoradiotherapy related complications and perioperative safety in mid-low rectal cancer patients. Methods The clinical data of 63 rectal cancer patients who received neoadjuvant (chemo) radiotherapies and surgery treatment in West China Hospital from Jul. 2014 to Feb. 2016 were retrospectively analyzed. According to the neoadjuvant regimen, the patients were divided into CRT group (n=15), SCRT group (n=30), and TNT group (n=18), and then the effects of these 3 kinds of neoadjuvant regimen on chemoradiotherapy related complications and perioperative safety were compared. Results ① Chemoradiotherapy related complications: among all the included 63 patients, 29 patients (46.0%) occurred chemoradiotherapy related complications, including radiation enteritis in 9 patients and bone marrow suppression in 25 patients. There were significant differences in the overall incidence of chemoradiotherapy related complications, incidence of radiation enteritis and bone marrow suppression (P≤0.001). The overall incidence of chemoradiotherapy related complications and incidence of bone marrow suppression of SCRT group were lower. ② Perioperative safety: no significant differences were found in the incidence of surgical complications, incidence of specific surgical complication, operation duration, intraoperative blood loss, and postoperative flatus time (P<0.05), but there was significant difference in the postoperative hospital stay among 3 groups (P=0.033), the postoperative hospital stay of SCRT group was shorter. Conclusion CRT, SCRT, and TNT have similar effect on the safety in the mid-low rectal cancer patients, which suggests that SCRT is worthy of further research and promotion.
Objective To assess the anal sphincteric function after intersphincteric resection for low rectal cancer by vectorial manometry. Methods Maximal anal pressure, vector volume, vector symmetric index and rectal anal inhibitory reflex were assessed in 16 patients underwent intersphincteric resection for low rectal cancer from 1999 to 2006. Thirty patients with low anterior resection for rectal cancer and another 30 healthy individuals were selected as control. Results The patients in intersphincteric resection group were subdivided into soiling group and defecation function good group. Maximal pressure, vector volume and vector symmetric index of the patients in soiling group and defecation function good group were significantly lower than those of the healthy and low anterior resection controls (P＜0.001). The maximal systole pressure, systole vector volume and vector symmetric index in soiling group were significantly lower than those in function good group (P＜0.001). The 25.0% patients in intersphincteric resection group had rectal anal inhibitory reflex， was significantly lower than that of the low anterior resection control group (93.3%, P＜0.001). Conclusion The maximal pressure and vector volume are compromised in patients underwent intersphincteric resection . The vectorial manometry can be an objective comprehensive tool for the evaluation of anal sphincter function in patients with intersphincteric resection.
目的总结低位直肠癌采用柱状经腹会阴切除术（APR）的应用体会。 方法徐州医学院附属医院普通外科于2010年1月至2013年7月期间采用柱状APR治疗22例低位直肠癌患者（柱状APR组），并与同期行传统APR治疗的35例患者（传统APR组）进行对比，分析术中、术后和随访的各项指标。 结果与传统APR组比较，柱状APR组的环周切缘阳性率及术中穿孔率明显降低〔4.55%（1/22）比34.29%（12/35）和4.55%（1/22）比31.43%（11/35）〕，差异有统计学意义（P＜0.05）；2组手术时间、术中出血量、并发症发生率比较，差异无统计学意义（P＞0.05）。术后随访3～30个月（平均21个月），柱状APR组无肿瘤复发及远处转移患者，未见死亡病例；传统APR组出现盆底局部复发4例，远处转移3例，死亡2例。2组局部复发、远处转移及死亡率比较差异均无统计学意义（P＞0.05）。 结论柱状APR可以切除更多的肿瘤周围组织，降低环周切缘阳性率，减少术中肠穿孔的发生，降低局部复发。
目的:比较低位直肠癌几种术式的复发率及5年生存率的差异,探讨术式的选择。方法:收集我院2001～2008年收治268例低位直肠癌病例资料,按局部切除,TME+DIXON、TME+MILES分成三组,对术后复发率及5年生存率进行回顾分析。结果:局部切除组12例,2年局部复发2例,复发率16.%,TME+DIXON组192例,总保肛率84.%,2年复发45例,复发率16.%,5年生存率61.%,TME+MILES术64例,2年复发11例,复发率17%,5年生存率59%,三组病例2年复发率相近,统计学数据显示无显著性差异(Pgt;0.5)。结论:对低位直肠癌,可根据病灶大小,病理学类型,Dukes分期等把握术式选择的适应症:保肛术式为首选, Miles术为最后的选择。