直肠癌是临床常见的恶性肿瘤之一，手术切除仍是目前治疗直肠癌的重要手段，Miles手术经历近100年的历史，已成为治疗直肠癌的金标准。当Miles手术推行半个世纪以后，人们开始对该手术需做永久性腹部结肠造口，给患者带来精神上的负担、生活和社交上的不便而引起重视。近年来，随着国民经济的发展和人民生活水平的不断提高，人们越来越重视在保住生命的同时，更要求有良好的生活质量。随着对直肠癌的解剖、病理、生物学特性及淋巴结转移规律的深入研究和探索，提出了新的概念、新的理论、新的观点和新的术式，使保留肛门括约肌功能的直肠癌根治术逐年增多，约占直肠癌外科手术的70%。保肛术式的发展逐渐取代了Miles手术，可显著提高患者的生活质量。目前直肠癌的外科治疗在知识创新和技术创新的推动下已进入一个蓬勃发展的阶段。
Seven hundred and eighty three cases of rectal carcinoma were treated in this hospital Jan. 1986 to Dec. 1994. There were 552 cases(70.5%)in which the tumor located in the middle and lower portion of the rectum. Of this group, 201 cases were treated with the operations of preservation of sphincter ani. The operations included transabdomino-sacral resection(5 cases), transpubic resection(5 cases), Dixon’s operation(67 cases), perineal pull through anastomosis(44 cases), Welch’s operation(68 cases), and local resection(12 cases). The 3-year survival rate was 90.9%. We consider that anal sphincter preservation is rational in the treatment of rectal cancer of middle and lower segment, As often os the radical resection and maintenauce of normal defecation is concerned, it is suitable for rectal carcinomas in Duke’s A and B1 stages. Combined treatment is necessary to prevent the recurrence and increase the survival rate.
目的 探讨直肠癌双吻合器保肛术后预防吻合口漏的措施。方法 回顾性分析2006年1月至2009年7月期间在我院行Dixon术的358例直肠癌患者的临床资料。结果 本组病例均一次吻合成功,术后出现吻合口漏30例（8.4%），多发生在术后5~10 d,均经非手术综合性措施治疗后漏口愈合,愈合时间14~60 d,中位时间37 d。结论 术前一般状况调整、术中严密操作、正确的引流管放置与灌洗引流、营养支持等综合性措施对低位直肠癌Dixon术后吻合口漏的防治效果较好。