低位直肠癌术式选择及评价

发布时间：2018-06-24 04:20

本文选题：低位直肠癌 + 手术方式　；参考：《中国实用外科杂志》2017年06期

【摘要】：手术医生的经验不同和病人的个体化差异往往产生不同的手术效果。直肠癌在国内以中低位多见,低位直肠癌有不同的手术方式。Dixon手术是根治性和保留肛门(保肛)最为满意的术式,经肛门和经骶后入路的局部切除适用于早期低位直肠癌,经肛门全直肠系膜切除适用于肥胖和骨盆狭窄的青壮年男性,Hartmann术用于不能耐受手术或已有肛门功能不全的老年病人,Parks术适用于只能与肛管吻合无法行Dixon手术或吻合器吻合的低位癌,Bacon手术用于不易与肛管吻合及预防漏的病人。括约肌间切除术是用于比上述肿瘤位置更低的早期直肠癌的保肛手术。Miles术和腹会阴柱状切除术用于不可保肛的病人。应根据病人情况及术者经验选择术式,并积极评估手术质量。低位直肠癌手术已发展为根治与功能保护并重,但要掌握保肛适应证,选择合理的术式。
[Abstract]:Different surgical experience and individual patient differences often produce different surgical results. Middle and low rectal cancer is more common in China. Dixon operation is the most satisfactory method of radical resection and preservation of anus (anus preservation). Local resection through anus and transsacral approach is suitable for early low rectal cancer. Transanal total mesorectal excision for obese and male adults with pelvic stenosis: Hartmann's procedure for elderly patients with intolerable or existing anus dysfunction can only be performed through Dixon's surgery or anastomosis with anal canal. Low-stage carcinoma with anastomosis of the combined device is used in patients with anus anastomosis and leakage prevention. Sphincterotomy is a sphincter preserving procedure for early rectal cancer with a lower location than above. Miles' operation and abdominal perineal column resection are used in patients with unconserved anus. We should choose the operative method according to the patient's condition and the experience of the operator, and evaluate the quality of the operation actively. Low rectal cancer surgery has developed into radical resection and functional protection, but we should master the indications of anal preservation and choose a reasonable operation method.
【作者单位】：中山大学附属第六医院结直肠外科广东省结直肠盆底疾病研究重点实验室;
【分类号】：R735.37

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