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目的：探讨全切除内括约肌和部分外括约肌仍保留肛门控制能力的低位直肠癌根治术。方法：自1991年7月至1994年12月对12例拒绝做腹壁人工肛门的低位直肠癌患者行直肠癌切除结肠肛管吻合术。9例肿瘤位于极靠近齿线的齿线上方，3例肿瘤达齿线。把直肠段翻转拖出肛门，在肛门外施行肛管及肛周组织的横断切除和结肠肛管的吻合。结果：肠管远端的切缘在齿线上0．2cm至齿线下1cm的范围，标本的远端切缘均为阴性。术后无并发症，临床随访显示全部病例肛门控制能力良好，生活正常。随访期间未发现局部病灶复发。结论：证实了完全切除内括约肌和部分外括约肌能保留肛门控制能力以及对特别低位的直肠癌施行根治性的保肛术的可行性。这种术式具有操作相对简单而不需要暂时性的回肠或结肠造瘘的优点，还适于肥胖及窄长骨盆患者。
OBJECTIVE: To investigate the radical resection of low rectal cancer with total anal sphincter and some external sphincter still retaining anal control. METHODS: From July 1991 to December 1994, 12 patients with low rectal cancer who refused to undergo an abdominal artificial anus underwent rectal cancer and coloanal anastomosis. Nine tumors were located above the dentate line near the dentate line, and 3 tumors reached the dentate line. The segment of the rectum was pulled out of the anus, and an anal canal and perianal tissue were transected outside the anus and the anal canal of the colon was anastomosed. RESULTS: The distal edge of the intestine was 0.2 cm below the tooth line and 1 cm below the tooth line. The distal edge of the specimen was negative. No postoperative complications, clinical follow-up showed that all cases had good anal control and normal life. No recurrence of local lesions was found during follow-up. Conclusions: The feasibility of complete resection of the internal sphincter and part of the external sphincter for preservation of anal control and for the feasibility of radical sphincter preserving surgery for particularly low rectal cancer was confirmed. This type of procedure has the advantage of being relatively simple to use without the need for temporary ileal or colostomy, and is also suitable for obese and long narrow pelvic patients.