直肠类癌68例临床病理分析及手术方式的探讨  

Clinicopathologic Analysis and Surgical Modality Selection of 68 Cases of Rectal Carcinoid

作　　者：吴国举[1] 肖刚[1] 周新平[1] 

机构地区：[1]卫生部北京医院普外科,100730

出　　处：《医学研究杂志》2013年第6期168-170,共3页Journal of Medical Research

摘　　要：目的分析直肠类癌的临床病理特征,探讨直肠类癌手术方式的合理选择。方法对笔者医院1999年3月2012年1月间收治的68例直肠类癌病例进行回顾性分析。其中经肛门局部切除术31例,结肠镜下肿瘤电切术9例,内镜黏膜下剥离术4例,经肛门内镜微创手术16例,直肠前切除术(LAR术)4例,腹会阴联合切除术(APR术)4例。采用SPSS 17.0软件进行统计学分析。结果 1、3、5年累计生存率分别为97.5%、95.5%、89.7%。直肠类癌最大径<2cm组与≥2cm组的生存比较有显著性差异;浸润肌层组与未浸润肌层组的生存比较有显著性差异;有淋巴结转移组与无淋巴结转移组的生存比较有显著性差异。结论肿瘤部位、大小、浸润深度及有无淋巴结转移是选择手术方式的重要因素。TEM为适合局部切除的直肠类癌患者提供了理想的术式选择。Objective To analyse the clinicopathologic characteristics and to investigate the rational selection of surgical procedures for rectal carcinoid. Methods The clinical pathological factors of 68 eases with rectal carcinoid treated by different surgical procedures in our hospital between March 1999 and January 2012 were analyzed retrospectively. Procedures included transanal local excision （ n = 31 ） , endoscopic mucosal resection （EMR） （ n = 9 ）, endoscopic submucosal dissection （ESD） （ n = 4 ）, transanal endoscopic microsurgery （TEM） （n = 16） , LAR operation （n =4） , APR operation （n =4）. The patients were divided into groups based on differents risk factoes. Results The 1 - year, 3 - year and 5 - year cumulative survival rates were 98.5% , 95.5% and 89.7% , respectively. The patients were divided into three groups based on the tumor size, muscular infiltration and lymph node transference. There was a statistically significant difference in the survival rate： between the tumor 〈 2cm and /〉 2cm groups, the groups without muscular infiltration and the groups with muscular infiltration, the groups without lymph node transference and the groups with lymph node transference. Conclusion The location, size, muscular infiltration and lymph node transference should be considered comprehensively before selecting surgical pro- cedures. TEM provides ideal alternative for patients with rectal carcinoid amenable to treat using local therapy.

关 键 词：直肠类癌 病理学 外科手术 经肛门内镜微创手术 

分 类 号：R735.2[医药卫生—肿瘤]