勉强做保肛手术的风险

术前分期3a期以上超低位直肠癌患者,勉强做保肛手术复发转移率很高。

第一节  不管从理论上还是经验上术前分期3b-3c期超低位直肠癌患者,做保肛手术风险巨大,得不偿失。

居于二十三章理论上讨论的综合因素和我六年肠癌群群主做解答时,看过的上千病例和数百跟踪诊疗过程和结果的经验;术前核磁分期3a期以上的3b-3c期超低位直肠癌患者,勉强做保肛手术或医生给保肛意愿强烈的患者做医学实验性保肛手术的患者,术后复发转移率非常高。这种分期和位置的直肠癌要求医生做保肛手术,其实就是给医生一个不可能完成的任务,患者不科学的靠意志保肛最后大概率的结果是肠癌周边医生为了保肛而无法切除干净很多的怀疑病灶,和理论上有机会被侵犯的人体组织和淋巴结,而这些术前术后做放疗降期或术后放疗补救的措施,也在放疗医生小心翼翼的不要误伤周边其它的功能器官而放疗不足,最后导致术后1-2年内复发转移了,就是幸运不会复发转移的患者,低于5公分的超低位直肠癌,医生在肿瘤下缘按指南下切2公分,艺高人胆大的医生下切1公分,也会切除掉一节内括约肌,或者放疗时伤害到非常敏感的探测功能器官内括约肌的探测功能,而导致术后屎屁部分,控制不了的肛门,冒着复发转移风险保下来一个功能不完整的肛门而后患无穷。

第二节  幸运不复发的患者肛门功能完好率很低很低,术后不堪大便无法控制重新回医院做造口手术的患者不在少数,术前核磁有以下描述的超低位直肠癌患者要果断放弃保肛的强烈愿望,科学治疗才能保命。

理论上超低位直肠癌低于距离肛门5公分,如4.5公分医生牺牲掉1公分的安全距离,冒险下缘切1公分,就已经要切除只有2公分的内括约肌0.5公分,等于切掉四分之一内括约肌了,而假如只有4公分,医生下切1公分,就要切掉一半的内括约肌了。虽然我没有找到研究报告论述理论上内括约肌切除一半之后,还能不能保持内括约肌的探测和跟外括约肌配合的肛门控制功能,但是,在实际的病例跟踪上,低于距离肛门4.5公分的超低位直肠癌患者,几乎专业医院的医生都不会帮患者做保肛手术,从几个地级市医院不专业的医院,给低于4.5公分以下的患者做保肛手术,也明显切除了部分或者全部的内括约肌的跟踪病例看来,术后肛门都无法控制,术后整天要穿着成人纸尿裤过日子,还一直担心会不会复发转移,做群主解答跟踪6年的病例,基本没有看过距离肛门4.5公分或者更低的超低位直肠癌患者做保肛手术之后,1-2年之后恢复肛门控制功能而且还不复发转移的病例,而复发转移的病例最多,术后不复发因肛门功能长久恢复不了,肛门无法控制想拉就拉,可以感觉到肛门不受控制的自我反复间歇性的自动收缩,苦不堪言还在苦苦等待的次之,而术后因不堪大便无法控制之苦回医院重新做永久造口的人也不在少数。

第三节  经验丰富的创群管理员也受不了保肛的诱惑,做了不坚定的决策,五年之后一切努力付之东流之时,我回复一个肛管癌患者群友的解答内容照登。

你在群文件看过我写的肛门的结构了吗?内括约肌上端就在4公分左右,而切除肿瘤下缘按照规范是2公分,4公分肠癌切除掉2公分,就把整个内括约肌给切除了,这样肛门的整体功能就破坏了,保肛还有意义吗?艺高人胆大的医生下缘切1公分,都要5公分以上超低位直肠癌患者才能够保住术后肛门的功能,而距离肛门4公分的位置是靠近盆腔的位置,那里直肠肠外就是包裹直肠的脂肪和盆腔壁,肿瘤出肠就侵犯盆腔,肿瘤不出肠癌细胞也可以通过淋巴管出肠侵犯周边的淋巴系统、脂肪和盆腔,而那个地方是非常的狭窄,特别是身体肥胖的患者,医生很难很难切除干净那个位置肠段周边的脂肪的,盆腔壁除了薄薄的一层皮之外就是骨头,那个地方被侵犯了,医生根本就不够距离切除病灶(无肉可切),

所以,侵犯盆腔就是晚期,这个地方切除肛门就能够清理掉所有的怀疑病灶,反正5公分以下的低位直肠癌都需要放疗内括约肌就要受到第一次伤害,手术再切除掉作为肛门探测功能的内括约肌,肛门功能术后可以正常控制的概率很低很低,理论上控制不了,而因为切不干净的风险却很大很大,所以,5公分以下保肛的复发转移率特别高!保下来的肛门还控制不了!保肛意志太过强烈的人,有些医生会满足患者的要求勉为其难的做保肛手术,但是复发转移的风险患者承担;根据群里无数次经验总结,低位保肛都是用命去堵的,而效果往往不尽人意,赌赢者寥寥!我只能讲解清楚之后提请群友慎重保肛,患者保肛意志强烈,医生也同意保肛,我再说不能够保肛,就显得皇上不急太监急了!这种付出生命教训的案例群里六年来比比皆是,就连创群管理员也犯了这个一失足成千古恨的严重错误,最后她老公上个月走了,她5年来的辛苦付出都付之东流,她是少有的好家属,她老公什么都不管,什么都不懂,每次造口放大便和换底盘全部都是她做的,半夜不睡守着给她老公放造口袋大便!可惜啊!第一步选择错误了,一步错步步错。最后她五年来的不懈努力都付之东流了!

第四节  《结直肠癌就诊、护理、调理、康复联盟网》将会开办《每周病例剖析栏目》每周与读者剖析一个病例进行互动

我创立的2000人的肠癌群建群6年来,聊天记录里保存了所有6年来的跟踪研究、指导、各种患者各种治疗、护理、调理的诊疗全过程对话语言和检查报告印证病例,也验证了无数的低位直肠癌和超低位直肠癌的就医、护理和调理过程的成功经验和失败教训,《结直肠癌就诊、护理、调理、康复联盟网》将会开办《每周案例剖析栏目》以每周剖析讨论一个有广泛代表性,或者典型的病例的方式,张贴出原始我这6年来跟这些典型病例患者或家属对话的病例就诊、治疗、护理、调理、康复的真实病例发展过程,让关心肠癌诊疗知识的患者和家属,都能够每周一次从这些经典病例中学习到某些知识和经验。

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