頁籤選單縮合
題名 | Clinical and Functional Results of Coloanal Anastom in Patients with Low Rectal Carcinoma=以結腸肛門吻合術治療直腸癌患者的經驗 |
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作者姓名(中文) | 林瑜崇; 林楨國; 林資琛; 梁長齡; 呂樹炎; 徐弘; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 26:5 民82.09-10 |
頁次 | 頁1996-2003 |
分類號 | 416.245 |
關鍵詞 | 直腸癌患者; 結腸肛門吻合術; |
語文 | 英文(English) |
中文摘要 | 對位於低位直腸癌的手術治療,外科醫師一直面臨口如何保留肛門功能及根除病灶的兩難,結腸肛門吻合術提供了外科治療此部位惡性腫瘤的選擇。從1986年到1990年共有21位直腸癌病患在臺北榮民總醫院接受結腸肛門吻合術,本文目的即是討論此種手術方式之療效,安全性及其長期之臨床及肛門功能結果。病人平均年齡為60.5歲,其中17例(80.9%)為男性。有16例(76.1%)的病例接受暫時性的結腸造口,而這些造口均於手術後二至三個月予以閉合。直腸腫瘤與肛門口的平均距離為6公分,而在病理標本上腫瘤下緣與切斷緣的平均距離為1.6公分。在21位病例中屬於杜克斯氏分期之A,B及C期的各有7例,其中沒有因手術死亡例,手術併發症的發生率為33.3%,包括1例發生吻合處泄漏,1例吻合處狹窄, 2例暫時性尿儲留, 1例直腸陰道瘻管及1例性功能失常。在這21位病人中,目前尚有13位病人仍然活存,而有8位已死亡,死亡的原因包括5位癌症末期,1位肺上皮癌,1位肝臟衰竭及1位自殺。有2例發生局部復發,局部復發率為9.4%。平均術後追蹤期為35.8個月,而所有病人的三年活存率為73%,80%的病人在手術一年後有良好的肛門控制功能。在較低位直腸癌的治療,經過病例的適當選擇,結腸肛門吻合術不失為一種安全有效的手術方式而且可以保留良好的肛門功能。 |
英文摘要 | The purpose of this study was to determine the efficacy, safety and long term clinical and functional results of coloanal anastomosis in patients with low rectal carcinoma. From June 1986 to July 1990, a total of 21 patients with low rectal carcinoma underwent curative proctectomy and restoration of bowel continuity by Parks' method of hand-sewn coloanal anastomosis. There were 17 male and 4 female patients whose ages ranged from 29 to 78 years ( mean 60.5 years ). Sixteen patients ( 76.1 % ) also had a preventive diverting colostomy, which was closed about two or three months after the initial operation. There were seven tumors involved in each of Dukes' A, B and C stages, respectively. The mean distance of tumor away from the anal verge was 6 cm ( range 5-8 cm ). The mean histologic distal clearance was 1.6cm ( range 0.5-3 cm ). All resected distal margins were histologically free from tumor invasion. The incidenec of postoperative complications was 33%. There was no operative mortality. Postoperative complications included one minor anastomotic leak, one anastomotic stricture, one rectovaginal fistula, one intestinal obstruction, one erectile impotence and two transient urinary retentions. The mean length of follow-up was 35.8 months (range 17-66 months). Among these 21 patients, 13 patients are still alive; and 8 have died. Causes of death were carcinomatosis in five of those; epidermoid carcinoma of the lung, hepatic failure or suicide were responsible in one each case. Two patients (9.4%) had solitary local recurrence. The overall three-year cumulative survival rate was 73% and one of the two patients followed up for more than five years is still alive. Sixteen of 20 patients (80%) had normal anal continence one year after curative operation. It was concluded that coloanal anastomosis is a safe and efficacious sphincter-saving operation in patients with low rectal carcinoma. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。