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하부직장암 수술시 괄약근보존술과 복회음절제술의 치료성적 비교

Comparative Study of Sphincter Saving Resection and Abdominoperineal Resection for Low Rectal Cancer

대한대장항문학회지 1997년 13권 2호 p.183 ~ 189
유창식 ( Yu Chang-Sik ) - 울산대학교 의과대학 외과학교실

김진천 ( Kim Jin-Cheon ) - 울산대학교 의과대학 외과학교실
정희원 ( Jung Hee-Won ) - 울산대학교 의과대학 외과학교실
이한일 ( Lee Han-Il ) - 울산대학교 의과대학 외과학교실
이강홍 ( Lee Kang-Hong ) - 울산대학교 의과대학 외과학교실
박건춘 ( Park Kun-Choon ) - 울산대학교 의과대학 외과학교실

Abstract


We compared the recurrence rate, survival and functional results of 159 low rectal cancer patients retrospectively, who had been performed 75 sphincter saving resections (SSR) and 84 abdomino-perineal resections(APR) during July 1989 to December 1994. The local recurrence rate was 9.3% in SSR and 8.3% in APR group, while systemic recurrence rate was 20.5% and 16.7%, respectively(p>0.05). Three year survival rate was 70% in SSR and 85% in APR group. Comparing with Dukes’stage, it was 69%, 89% in Dukes’B and 63%, 84% in Dukes’c stage, respectively(p>0.05). In respect to the number
of metastatic lymph node,3 year survival rate was 80%,95% in Nl group(≤3 metastatic lymph nodes) and 61%,72% in N2 group(≥4 metastatic lymph nodes), respectively(p>0.05). According to the distal resection margin(DRM), it was 100% in
group 1(1 cm≤DRM<2 cm), 63% in group 2(2 cm≤DRM < 3 cm) and 72% in group 3(DRM≥ 3 cm), respectively(p>0.05). Voiding dysfunction was developed 36.0% of SSR and 28.6% of APR postoperatively. Erectile and ejaculatory dysfunction rate was 33.3%, 66.7% of SSR and 58.8%, 88.3% APR group respectively, There were no significant differences in recurrence rate, survival rate and functional results Between SSR and APR group. Conclusively, sphincter saving resection in low rectal cancer surgery did not seem to affect survival or recurrence. A good functional outcome in the SSR suggests it to be a procedure of choice, if possible.

키워드

Low Anterior Resection;Miles’ Operation
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