Clinical Analysis Of Miles In 11 Cases Of Low Rectal Cancer

Objective: To study the application value of rectal examination,endorectal ultrasonography(ERUS)and 3.0 Tesla magnetic resonance imaging(3.0T MRI)in the preoperative evaluation of low rectal cancer,and to make a inital exploration for reasonable application of intersphincteric resection(ISR)in low rectal cancer.Methods: A total number of 11 patients with low rectal cancer who received Miles operation in the First Affiliated Hospital of Guangxi Medical University Colorectal anus surgery during the time from April 2016 to March2017 were finally recruited.Data of distance from the lower edge of the tumor to inter sphincter groove were measured by three methods: rectal examination,ERUS and MRI.The results were compared with those measured in fresh specimens postoperatively;T stage of rectal cancer were performed by ERUS and MRI before operation,and compared with the postoperative pathological T stage.Histopathological large slice HE staining method was used to evaluate thelocal invasion of the tumor.Finally,by analyzing the distal margin and local invasion of the tumor,it can be concluded whether ISR can achieve R0 resection in the anus preserving treatment of low rectal cancer.Results:1,The average lengths from the lower edge of the tumor to inter sphincter groove were(2.25±0.44)cm,(2.86±0.66)cm,(2.52±0.50)cm and(2.21±0.68)cm in view of rectal examination,ERUS,MRI and fresh specimens postoperative respectively.Among them,the distance measured by ERUS was compared with the distance of postoperative specimens,the difference was statistically significant(P < 0.05),while both the rectal examination and MRI were not.2,Postoperative pathological examination showed that: there were 5cases of T2 stage,4 cases of T3 stage,2cases of T4 stage,but no T1 stage case.The coincidence rate of preoperative T stage and postoperative pathology was63.6%(7/11)in ERUS,and MRI coincidence rate was 72.7%(8/11).3,After large slice HE staining showed that tumor infiltration are as follows: 11 cases were not involving the intersphincteric groove;7 cases without infiltration of internal sphincter,4 cases involving the internal sphincter;without external sphincter infiltration in 10 cases,1 cases involving the external sphincter;1 case with levator ani muscle invasion.Conclusion: 1,Compare with ERUS,the results of rectal examination and3.0T MRI measurement are more reliable than that of low rectal cancer.2,The effect of ERUS and 3.0T MRI on preoperative T stage in low rectal cancer is equivalent.3,For early and middle stage in low rectal cancer which located above the dentate line,especially for patients without tumor invasion of the external anal sphincter,ISR may be considered after adequate preoperative evaluation.