关键词: 直肠全系膜切除术, 经内外括约肌间切除, 直肠癌, 保肛手术

Abstract:

Objective To report the experiences and preliminary results of TME plus intersphincteric resection as the sphincter-saving procedure for ultra-low rectal cancer. Methods 31 rectal neoplasm patients whose distal tumour edges were ≤2 cm from the dentate line were evaluated preoperatively. Eighteen patients with advanced rectal cancer received preoperative chemoradiotherapy. The TME were performed by abdominal operation group and then the puborectal ligament and partial levator ani were dissected approaching to the upper edge of external sphincter ring. It was possible to go down further to dissect 1～2 cm between the external sphincter ring and the rectum inner sphincter wall. The surgeon of anal operative group dissected all layer of rectum inner sphincter vertically to the longitude axis of the anal canal 2 cm below the lower edge of malignancy and then further mobilized ascending to meet with the abdominal group. Colon or colon pouch were anastomosed to distal anal wall. Results There was no operative death and no evidence of recurrence or metastasis in twenty-six patients. The rectum cancer recurred 1 year after operation in one patient, another one had rised level of CA19-9 but without documents of metastasis. 30 patients were satisfied with their fecal control. The average-time of follow-up is 24 months. Conclusion Radical resection could be attained and anal sphincter could be saved by TME plus intersphincteric resection. It is an alternative sphincter-saving method to early stage rectal cancer, or some advanced rectal cancer which were sensitive to preoperative chemoradiotherapy, or ultra-low rectal parenchamal tumour, or wide based polyps, and for patients with extremely strictured pelvis.

Key words: TME, inter-sphincter resection, rectum cancer, sphincter-saving procedure