低位直肠癌的局部切除结果及预后因素分析  

Clinical results and prognostic analysis of local excision in lower rectal cancer

作　　者：张海增[1] 张兵[2] 周志祥[1] 邵永孚[1] 

机构地区：[1]中国医学科学院肿瘤医院腹部外科,北京100021 [2]内蒙古医学院附属人民医院普外科

出　　处：《中华外科杂志》2008年第18期1390-1393,共4页Chinese Journal of Surgery

摘　　要：目的总结低位直肠癌局部切除的结果，分析影响预后的因素，探讨提高低位直肠癌局部切除疗效的方法。方法回顾性分析1985年2月至2007年10月收治的76例低位直肠癌局部切除患者的临床病理资料。结果76例患者中采用经肛切除69例，经骶切除6例，经阴道切除1例。肿瘤分期其中T1期48例，他期25例，T3期3例。手术并发症发生率为7．9％，无手术死亡。局部复发率为22．4％，5年总体生存率84．5％。单因素分析提示肿瘤复发与肿瘤的T分期、切缘阳性显著相关，多因素分析显示T分期和切缘距离是与局部复发相关的独立影响因素。生存分析显示黏液腺癌、切缘阳性、血管淋巴管浸润显著影响术后的长期生存，而切缘阳性和血管淋巴管浸润是影响术后长期生存的独立预后因素。结论局部切除安全性高，合理选择病例是低位直肠癌治愈性局部切除成功的关键。低位直肠癌局部切除的适应证为无高危因素（分化差、血管淋巴管侵犯、黏液腺癌）的T1-2，N0期患者；T2期术后应行放化疗。Objective To analyze the results and the prognosis of local excision of lower rectal cancer, and investigate the proper indication of local excision for cure purpose. Methods The clinicopathological data of 76 patients with lower rectal cancer treated from February 1985 to October 2007 were analyzed. Results Sixty-nine patients received transanal excision, 6 cases received transscaral excision and 1 case received transviginal excision. Among the cases, 48 cases were ranged as TI phase, 25 cases as T2,3 cases as T3. The operation complication rate was 7.9%, and the 30-day mortality rate post operation was 0. The local recurrence rate was 22.4% and the overall 5 year survival rate was 84. 5%. The local recurrence was significantly related with T stage and resection margin status. The survival was significantly related with mucinous adenocarcinoma, resection margin status and lymphovascular invasion; and the resection margin and lymphovascular invasion was the independent factors affecting survival. Conclusion Local excision was safe in early stage lower rectal cancer. Careful patient selection is the key of the operation. The proper indication of local excision is T1-2 without high risk factors （high histopathological grade, presence of lymphatic or vascular invasion, mucinous adenocrcinoma） ; and the cases with T2 phase tumor should undergo chemoradiotherapy after local excision.

关 键 词：结直肠肿瘤 局部切除 预后 

分 类 号：R686[医药卫生—骨科学]