经肛门局部切除治疗直肠癌116例  

Transanal local excision for rectal carcinoma

作　　者：李晓霞[1] 孙公平[1] 逯晓波[2] 王辉[3] 

机构地区：[1]中国医科大学附属第四医院胃肠外科,沈阳110032 [2]中国医科大学公共卫生学院 [3]辽宁省肿瘤医院大肠外科

出　　处：《中华普通外科杂志》2010年第3期209-212,共4页Chinese Journal of General Surgery

基　　金：辽宁省教育厅高等学校科研基金资助项目（2008781）;辽宁省自然科学基金资助项目（20062053）

摘　　要：目的探讨经肛门局部切除术治疗直肠癌的影响因素及预后。方法回顾性分析1995-2008年116例采用经肛门局部切除术治疗直肠癌患者的临床资料，主要采用Cox比例风险模型进行多因素生存预后分析。结果116例患者术后生存时间为14～160．5个月，中位生存时间为58．5个月。总体生存率5年为72％，10年为53％。局部复发16例，复发率为13．8％。单因素分析表明肿瘤的病理类型、浸润深度（T分期）、复发及转移均为预后影响因素。多因素回归分析表明肿瘤浸润深度（T分期）、复发转移情况是影响生存预后的独立因素。T1期直肠癌患者，局部复发率为6．3％，5年生存率为93％，10年生存率为85％；T2期直肠癌患者，局部复发率为14．8％，5年生存率为63％，10年生存率为45％。T1期患者接受辅助放疗后，无局部复发；T2期患者接受放疗后，局部复发率为14．6％。接受辅助放疗与未接受辅助放疗患者的生存预后情况进行比较，通过绘制生存曲线发现无统计学意义（T1：P=0．260，T2：P=0．262）。接受辅助放疗与未接受辅助放疗患者术后局部肿瘤复发情况进行比较有统计学意义（P=0．002）。结论经肛门局部切除术对于T1期直肠癌治疗效果较好，T2期直肠癌不适合采用经肛门局部切除术治疗。辅助放疗可降低术后直肠癌的局部复发率。Objective To evaluate the therapeutic effects and prognostic factors of transanal local excision of rectal carcinoma. Methods We retrospectively analyzed 116 cases who underwent transanal local excision for rectal carcinoma from 1995 to 2008 with the mentod of Cox Regression analysis. Result The survival time of all the patients were from 14 to 160. 5 months, median time was 58.5 months. Five-year overall survival rate was 72% , ten-year overall survival rate was 53 %. There were 16 cases of local recurrence, with a rate of 13.8%. In the univariate survival analysis： histopathology, depth of tumor invasion, radiotherapy, recurrence and metastases were the predictors of survival. In the Cox regression analysis：depth of invasion, recurrence and metastases were the independent prognostic factors for survival. For T1 stage, its overall local recurrence rate was 6. 3%, five-year overall survival rate was 93%, ten-year overall survival rate was 85% ; For T2 stage, its overall local recurrence rate was 14. 8%, five-year overall survival rate was 63% ,ten-year overall survival rate was 45%. For TI stage, there was no local recurrence with radiotherapy; For T2 stage,local recurrence rate was 14. 6%. From the surivival curve, there was no difference between the patient accepted radiotherapy or not （ T1 ： P = 0. 260, T2, P = 0. 262 ）. But for local recurrence, the differences was significant （P = 0. 002 ）. Conclusion The result of transanal local excision of rectal carcinoma is satisfactory with T1 stage, but it is not suitable for T2 stage tumors.

关 键 词：直肠肿瘤 外科手术 放射疗法 预后 

分 类 号：R735.37[医药卫生—肿瘤]