The North Hospital of Yulin Hospital of Traditional Chinese Medicine of Shaanxi Province, Yulin 719000, ChinaZhan Feng SongFrom June 2000 to
The North Hospital of Yulin Hospital of Traditional Chinese Medicine of Shaanxi Province, Yulin 719000, China
Zhan Feng Song
From June 2000 to June 2005, a total of 87 cases of low rectal cancer were treated in our department. Among them, 53 cases were treated with low anterior resection and sphincter preserving technique. The anal sphincter rate was up to 60.9%.
Materials and methods
1 general data of the 53 cases, male 33 cases, female 20 cases, aged 35 to 73 years old, average 58.3 years old, preoperatively diagnosed by colonoscopy and pathology examination confirmed the diagnosis of rectal cancer. The lower margin of the tumor was 5 to 7cm5 from the anal margin in, and the patients were from 7 to 10cm. There were 20 cases of high differentiated adenocarcinoma, moderately differentiated adenocarcinoma, 26 cases of poorly differentiated adenocarcinoma and 1 cases of adenocarcinoma of the prostate, after operation.
2 surgical methods according to the total mesorectal excision (TME) principle, in sharp separation of presacral pelvic wall and visceral, rectum and pelvic bottom free, keep the visceral fascia intact from the lower margin of the tumor than 2cm cut off the rectum, the distal stump application closed or manually closed distal intestinal cavity flushing with the physiological salt of antitumor drugs, application of stapler for colon, rectal or anal anastomosis, a lot of hot distilled water and pelvic peritoneal lavage.
There was no operative death. Intraoperative presacral hemorrhage in 3 cases, application of hot saline gauze oppression, biological glue, nail head nail into the sacral methods of hemostasis. Postoperative pathological report margin no tumor residue. No anastomotic leakage occurred in all cases. 3 cases of postoperative intestinal dysfunction, 2 cases were cured with conservative treatment, 1 cases with anastomotic stenosis, conservative treatment is invalid, for descending colostomy; another 2 cases of anastomotic stenosis were cured by conservative treatment. The anal function of all patients were good, no fecal incontinence, some cases of early increased stool frequency, but can control defecation. The follow-up rate was 71.7% (38/53). The follow-up period was from October to the end of 40 months. Local recurrence occurred in 2 cases, with a recurrence rate of 5.3% (2/38).
Low rectal cancer, high incidence of colorectal cancer in China is the two major characteristics of , in China, accounting for about 70% of colorectal cancer, while the colorectal cancer below the peritoneal fold accounted for about 75% of the total rectal cancer. Since 1908 the first Miles abdominoperineal resection has greatly improved the rectal cancer radical resection rate and survival rate of low rectal cancer, has become the "gold standard", but because the operation shall at the same time in the abdomen for permanent colostomy, patient burden, in the thought of life and work inconvenience in order to improve the quality of life; people's opinions from a single "cancer cure, the preservation of life", to "double standard cure disease and improving the life of the sphincter preserving surgery has become the preferred surgical treatment of low rectal cancer surgery, abdominoperineal radical Miles surgery has been from the" gold standard "drop as the last option .
A number of basic and clinical studies confirmed , diffusion of peritoneal lymph folds the only upward direction, there is no lateral and downward diffusion, lymphatic spread direction below the peritoneum of rectal cancer is mainly in upward direction, only a handful of highly malignant tumors or cancer to the direction of the lymphatic cancer embolus was blocked, only retrograde downward lymphoid proliferation changed the Miles proposed how the parts of both rectal cancer, lymphatic spread both upward and downward direction, the lateral diffusion point ; the majority of scholars believe that the rectal wall longitudinal infiltration, retrograde downward infiltration more than 95% of not more than 2cm, and less than 5% of the more than 2cm, the majority of DukesD patients with high degree of malignancy, therefore, colorectal cancer Chinese Specialized Committee suggested that the distal rectal cancer In addition to 3cm, to ensure the thoroughness of the tumor resection, the concept of more than half a century after the removal of the tumor must be removed more than 5cm point of view. In these cases, we resected distal stump continuous biopsy confirmed tumor infiltrating 2cm, distally within 52 cases, only 1 cases of distal infiltration of 2.5cm, poorly differentiated adenocarcinoma; distal mesenteric tumor in only 2 cases with lymph node metastasis, were poorly differentiated adenocarcinoma. In addition, when the arc lies on the concave anterior sacral rectum is fully free, can be extended from 3 to 5cm, the past that cannot be done with low or ultralow resection of anus preserving operation possible. In this group of cases, 5 cases of patients with 5 ~ 7cm, after the full free, can be cut margin without residual low resection and anastomosis. In 80s the beginning of the last century, Heald proposed the total mesorectal excision for rectal cancer surgery principle , since 90s, the wide application of double stapling technique , the rate of anus preserving rectal cancer from less than 30% to more than 70%, and the local recurrence rate from 30% to 50% below 10%. Make the most of the patients with low rectal cancer to "treat disease, improve the double standard of living, quality of life was greatly improved. Rectal cancer surgery make the majority of low rectal cancer patients achieved "treatment of diseases, improvement of life", but the primary goal of anus preservation operation is still the "treating disease", emphasizing the thoroughness of surgery, the anus cannot depend on the subjective desire of individuals, must follow certain principles. To keep the normal defecation control function and improve the quality of life. The anal continence is controlled by a healthy sphincter function and a complete sensory reflex. The thoroughness of tumor resection and radical dissection of lymph node dissection were emphasized. We must follow the principle of total mesorectal excision (TME) to maintain the integrity of the pelvic fascia, and the resection of the distal part of the tumor should be no less than 5cm. The tumor of distal bowel resection is not less than 2 ~ 3cm. That is fully free of tumor from the distal rectum above the dentate line 5cm, in order to retain the levator muscles, anal sphincter intact.
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