王军 冯树开 徐托 冯淑娟 戴思敏

[摘要] 目的 分析直腸癌患者临床行保肛术、Miles术，患者术后生存质量、生存率、复发率差异情况。 方法 方便选取2011年8月—2013年1月期间入院行直肠癌手术治疗的67例患者作为该次研究对象，按患者病床单双号进行分组，其中对照组33例（行Miles术）、观察组34例（行套入式直肠黏膜吻合保肛术），所有患者门诊随访5年，对比患者术后2、5年直肠癌复发率、生存率情况，对患者生活质量、生存质量采用卡式表（KPS）以及QOL进行评分，统计术后早期患者并发症发生情况以及癌细胞远处转移率。 结果 术后观察组生存质量为（86.2±3.5）分、生活质量（48.1±3.2）分，高于对照组（81.7±3.2）分、（42.0±2.8）分，（t=5.488、8.294，P<0.05）;5年生存率、复发组间比较差异无统计学意义（P>0.05）;观察组并发症发生率为8.8%，低于对照组21.2%（χ2=6.030，P<0.05），远处转移率组间比较差异无统计学意义（P>0.05）。结论 直肠癌患者临床以保肛术、Miles术治疗，5年生存率较高、复发率较低，但保肛术术后并发症少，且能有效提高患者生存质量及生活质量。

[关键词] Miles术;复发率;保肛术;生存率;直肠癌

[中图分类号] R735.3          [文献标识码] A          [文章编号] 1674-0742（2018）08（c）-0079-03

The Effect of Anus-preserving Operation and Miles Operation on the Recurrence Rate and Survival Rate of Rectal Cancer

WANG Jun， FENG Shu-kai， XU Tuo， FENG Shu-juan， DAI Si-min

Department of General Surgery， Yangdong District People's Hospital， Yangjiang， Guangdong Province， 529500 China

[Abstract] Objective To analyze the clinical practice of anus-preserving operation and Miles operation in patients with rectal cancer. The differences of postoperative quality of life， survival rate and recurrence rate were analyzed. Methods 67 patients undergoing surgery for rectal cancer during the period from August 2011 to January 2013 were convenient selected and included in this study. The patients were divided into two groups according to the patient's sickness bed number， including 33 patients in the control group （with Miles） and 34 patients in the observation group （row insertion Rectal mucosal anastomosis preservation of the anus）， all patients were followed-up for 5 years in the out-patient department， and the recurrence rate and survival rate of the rectal cancer were compared between 2 and 5 years after operation. The KPS and QOL were used for the quality of life and quality of life of the patients. Scoring was performed to count the occurrence of postoperative complications and the distant metastasis rate of cancer cells. Results The quality of life in the postoperative observation group was （86.2±3.5） points and the quality of life was （48.1±3.2） points， which was higher than that of the control group（81.7±3.2） points，（42.0±2.8） points（t= 5.488， 8.294， P<0.05）; There was no significant difference between the 2-year 5-year survival rate and the recurrence group（P>0.05）; the complication rate in the observation group was 8.8%， lower than the control group of 21.2%（χ2=6.030， P<0.05）， there was no significant difference in distant metastasis rates between groups（P>0.05）. Conclusion The patients with rectal cancer should be treated with anus-preserving operation and Miles surgery. The 5-year survival rate is higher and the recurrence rate is lower. However， the postoperative complications of anus-preserving surgery are less， and the quality of life can be effectively improved.

[Key words] Miles surgery; Recurrence rate; Anus-preserving surgery; Survival rate; Rectal cancer

直肠癌作为常见恶性肿瘤疾病，相关数据显示我国发病率仅排在胃癌之后，疾病早期多数无症状，但随着病情发展逐渐出现排便习惯改变、阴部疼痛、尿路刺激等症状，若不及时治疗不仅给患者造成痛苦，还危及其生命安全。目前疾病治疗以手术为主，其中Miles术为常用治疗手段，其能对病灶进行切除，在提高患者生存率方面具有积极性意义，但需要在患者腹部做永久性肠造口，这不仅造成排便方式改变，还易出现感染、吻合口漏等情况，严重影响患者身心健康[1]。……