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世界核心医学期刊文摘（胃肠病学分册） 2006年第3期2卷 23-24页

作者： schiessel r. Novi G. Holzer.B. 郑世成 Danube Hospital/SMZ-OST Langobardenstrasse 122 A1220 Vienna Austria.Dr

PUr.OSE: Inter.phincter.c r.section of low r.ctal tumor. is a sur.ical technique extending r.ctal r.section into the inter.phincter.c space. This pr.cedur. is per.or.ed by a synchr.nous abdominoper.neal appr.ach with mesor.ctal excision and excision of the entir. or.par. of the inter.al sphincter. This study was designed to evaluate the long-ter. r.sults of this method focused on continence function and oncologic r.sults. METHODS: Fr.m 1984 to 2000, a total of 121 patients wer. oper.ted on. The patients wer. evaluated pr.spectively accor.ing to a detailed pr.oper.tive and postoper.tive pr.gr.m. r.SULTS: One hundr.d seventeen patients had r.ctal cancer., two had dysplastic villous adenomas, and two had car.inoid tumor.. Cancer. wer. staged accor.ing to the Dukes classification (Stage A in 41 per.ent, Stage B in 28 per.ent, and Stage C in 31 per.ent; median distance fr.m the anal mar.in, 3 (r.nge, 1-5) cm). Postoper.tive complications wer.: one death because of pulmonar. embolism, 5.1 per.ent developed an anastomotic fistula, one patient had a fistula to the bladder.r.quir.ng r.oper.tion, one patient with ileus needed r.lapar.tomy as well as one for.intr.-abdominal hemor.hage and a small-bowel fistula. One patient developed a fistula after.closing the pr.tective colostomy. Five patients developed late str.ctur.s of the coloanal anastomosis. After.a median follow-up of 72.86 months, 5.3 per.ent of patients developed local r.cur.ence. The continence status was satisfactor. with 16 patients (13.7 per.ent) showing continence for.solid stool only, and 1 patient (0.8 per.ent) showing episodes of incontinence. A tr.nsient pr.blem was a high stool fr.quency after.closur. of the pr.tective stoma. CONCLUSIONS: Inter.phincter.c r.section is a valuable pr.cedur. for.sphincter.saving r.ctal sur.er.. We showed that this technique has satisfactor. long-ter. r.sults in functional and oncologic r.spects. An impor.ant pr.r.quisite is a car.ful pr.oper.tive evaluation of local tumor.spr

关键词：括约肌间直肠系膜绒毛状腺瘤外括约肌直肠切除直肠手术吻合口瘘结肠直肠吻合术小肠瘘不良

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Pr.gr.ss in the sur.er. of r.ctal cancer

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Jour.al of Acute Disease 2018年第1期7卷 26-30页

作者： r.dolf schiessel Em.Chief Depar.ment of Sur.er. Donauspital Vienna3400 KlosterneuburgJasmingasse 2Austria

The tr.atment of r.ctal cancer.has been impr.ved a gr.at deal within the last 20 year.. Major.pr.gr.ss has been made in the pr.oper.tive evaluation by intr.ducing Mr.- imaging as a basis for.the fur.her.management. Neoadjuvant r.diochemother.py has been shown to be effective in downstaging of advanced tumour.. The sur.ical technique has been impr.ved in many r.spects.- Total mesor.ctal excision has r.duced local r.cur.ences, sphincter.saving techniques such as low anter.or.r.section and inter.phincter.c r.section r.duced the need for.a per.anent stoma to 10%-20%. r.cently the intr.duction of minimal invasive techniques and the application of r.botic systems have r.duced the sur.ical tr.uma.

关键词： r.ctal cancer Sphincter salvage Inter.phincter.c r.section Sphincter r.placement r.botic sur.er.

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