Objective to explore the best selection of operation mode of elderly low rectal cancer patients. Method by analysis of 39 cases, set out for surgery in the elderly patients to take more appropriate ways. Results 39 elderly low rectal cancer patients free of surgical mortality, anastomotic fistula and anastomosis stenosis are cured and discharged. Postoperative follow-up 5 years on average, 30 patients alive, locally recurrent cancer 1 case. Conclusions based on the characteristics of elderly patients, combined with specific situations, as long as strict control indications, correct choice of operation, it will enable greater success in his anus.
The incidence of colorectal cancer in China followed a rising trend, seriously affecting the patients ‘ lives and health, in particular the middle and low rectal cancer, the traditional surgical method to Miles for mainstream, the total for the tumor, the establishment of artificial anus. Human destruction of normal bowel channel structure, increased the burden and pain of patients, a great deal of inconvenience to live and work, and unique ways of thinking are mostly elderly patients to undergo such surgery, causing some patients to give up treatment.
Since 1999-2006 in our hospital admitted a total of 39 cases of senile patients with lower rectal cancer, according to the characteristics of elderly patients, according to the actual situation choice acceptable low resection and sphincter-preserving surgery in the elderly-and achieved good results, are reported below.
1 data and methods
1.1 General information on this group of patients with a total of 39 cases, men and 30 cases, female 9. Age 64~78sui, average age of 71. 38 cases of preoperative other diseases (97.4%), 31 cases of merging two or more diseases (79.5%). These are the characteristics of elderly patients: a case, merge with other diseases. Pathological types: 2 cases of poorly differentiated adenocarcinoma, adenocarcinoma in 25 cases, high differentiation adenocarcinoma in 11 cases, malignant lymphoma: report of 1 case.
1.2 in a surgery 39 cases of 37 cases of TME principle line of anterior resection of rectal carcinoma and pelvic autonomic nerve preservation. Cancer under mesorectal resection margin not less than 5 cm, while cutting off bowel distance based on tumor size, type and wall infringement decision, ranging from 1~3 cm. After the separation of the rectum is fully in accordance with anastomosis stapling or manual, rinse prior anorectal anastomosis. This group uses the anastomosis of 30 cases, using double stapling technique for 6 cases of which are above the dentate line 1~2 cm ultra low anastomosis, anastomosis of double-distilled water 4000 ml 43 ℃ pelvic flushing on completion. Manipulation of 7 cases where external anal colorectal manipulation of 2 cases. 2 other routine low local excision.
This group without mortality, anastomotic fistula and anastomosis stenosis occurs no, 39 cases were cured and discharged. Full set of 39 cases have been followed up, follow-up 5 years on average, 30 patients alive, locally recurrent cancer 1 case. When for 4 months after review, 36 cases of bowel functions returned to normal, defecation 1~2 times/d,3 cases of constipation, dressed in uniforms or laxatives, 4 cases of anal eczema occur. 2 cases of 6 months after acute myocardial infarction and died 9 months. 2-3 years after the death of 4 cases, including pelvic lymph node metastases in 1 case, 2 cases of lymphatic metastasis, ovarian metastasis in 1 case. 3 cases of 4-5 years after death, for liver metastases.
Colorectal cancer accounts for second place in the digestive tract malignant tumors, 75% of low rectal cancer and rectal cancer. Surgical treatment is mainly used Miles past surgery, colostomy in order to ensure the radical effect, but after operation in patients with serious effects of the quality of life. Retired elderly patients at home in our hospital, some patients character odd-tempered, small social circle, ideologically difficult to keep up with the development of the current situation, one-sided extremes on the problems and deal with problems, such as when you own major diseases, it is difficult to correct. When the big disease rectal cancer, but also to the establishment of artificial anus, quality of life decreased significantly, are difficult to accept, often refuse any treatment, so radical and retention is the focus of controversy in elderly low rectal cancer patients [1,2]. At this time as a doctor it is necessary to consider to maximize retention of normal physiological functions, improve the quality of life, and radical resection of tumors, thereby reducing the recurrence rate, increasing the survival rate. Study on Anatomy of the rectal and perirectal tissue structure and increased awareness of rectal cancer pathology, Physiology, and mouthparts of anastomosis operation method widely use and continuous improvement, clinical application of double stapling technique in obviously improve the success rate of sphincter-preserving surgery for rectal cancer . Treatment of rectal cancer by a single pursuit “cancer eradication, save lives” into “cancer eradication, better living” double standards. Become a preferred method for anus.
Some scholars suggested that ideal radical resection of rectal carcinoma should meet the following criteria: cure cancer, and local control, good anal function, and normal urination and sexual function [4,5]. Rectal cancer of connective tissue surrounding the operation must be completely clear, and a plane that its removal should be below the level of resection of intestine itself, to reduce local recurrence, and on this basis and strive to retain the anus . From the above point of view of experts, is on the premise of trying not to increase local recurrence, consider lines of resection of Ultralow-with a view to achieve the purpose of anus, first of all, to achieve this aim we need strict control indications, will not increase because of sphincter-preserving surgery for locally recurrent. Second is to choose the correct operation. Operation selection varies, discrimination, poor economic conditions, pelvic exposure clearly available techniques of anastomosis. While the economic situation a little better, possible staplers. Also called surgeons familiar with the anatomy knowledge, possess excellent surgical skills. As Heald introduced in 1982, such as total mesorectal excision (TME) this new technology, we are in strict accordance with the requirements of this technology in action, according to this technology for surgery will definitely reduce postoperative local recurrence rate, in fact, studies have confirmed this point that many scholars [7,8]. Currently think rectal cancer Xia margin 2 cm is security of, on low differentiation cancer focal, if distal resection less than 2 cm or operation in the has suspected of patients should will distal anastomosis ring line operation in the frozen slice check, to guarantee distal no cancer cells, lesions intestinal segment resection down rectal washing [9,10], anastomosis Manager technology of progress makes TME of low anastomosis became more easy, rectal residual end in anal reference muscle above retained 2~4 cm (anastomosis mouth General from anal margin 5~8 cm) is can security anastomosis [9,11,12]. To reduce postoperative voiding dysfunction and sexual dysfunction, require surgeons familiar with the anatomy of pelvic autonomic nerves, carefully during the operation, protect nerve, have not been affected by the preserved neural radical thoroughness. Third, the peri-operative treatment, to prevent anastomotic fistula occurs, making the preoperative preparations in rigorous detail, strengthen nursing after the operation.
So for elderly low rectal cancer patients, resection of low rectal cancer, not only cure the tumor, also of maximum possible retention of the anal sphincter function, which emphasized humanism and humanistic care improves patients ‘ quality of life, has made great achievements in clinical. As long as the accurate indication, follow the principle of non-tumor, proper selection of its operation, be the best treatment of middle and lower rectal surgical methods.