经肛门局部切除术治疗低位直肠癌  

Transanal local excision for rectal cancer

作　　者：杨玉波[1] 潘克勤[1] 刘俊峰[1] 郑泽霖[2] 

机构地区：[1]吉林省肿瘤医院腹部外科,吉林长春130012 [2]吉林大学中日联谊医院基本外科,吉林长春130031

出　　处：《中国普通外科杂志》2001年第6期494-496,共3页China Journal of General Surgery

摘　　要：目的　总结经肛门局部切除术治疗低位直肠癌的经验。方法　回顾性分析 1988～ 1998年收治的 2 8例经肛门局部切除术者的临床资料。结果　本组 5年生存率为 (83.4± 6 .2 ) % ,复发率为 17.8%。高分化腺癌 4例复发 ,复发率为 17.4% (4 /2 3) ;中分化腺癌1例复发 ,复发率为 2 0 0 % (1/5 )。T1期复发 3例 ,复发率为 15 0 % (3/2 0 ) ;T2 期复发 2例 ,复发率为 2 5 0 % (2 /8)。肿瘤基底小于肠壁周径 1/3者复发 4例 ,复发率为 16 .7% (4 /2 4) ;肿瘤基底大于肠壁周径 1/3者复发 1例 ,复发率为 2 5 0 % (1/4 )。全层肠壁切除复发3例 ,复发率为 16 .7% (3/18) ;部分肠壁切除复发 2例 ,复发率为 2 0 0 % (2 /10 )。肿瘤直径 <4cm复发 3例 ,复发率为 15 .8% (3/19) ;肿瘤直径 >4cm复发 2例 ,复发率为 2 2 .2 %(2 /9)。结论　经肛门局部切除术治疗直肠癌适于T1～T2 、N0 M0 、组织分化好、距肛缘 6cm以内的肿瘤。严格掌握适应证 ,完整的肿瘤切除 ,术中预防肿瘤种植是预防复发的关键。术后应进行密切随访 。Objective To summarize the experience in transanal local excision (LE) for rectal cancer (RC). Methods The clinical data of 28 cases of RC treated by LE from 1988 to 1998 were analyzed retrospectively. Results In this series, five-year survival rate was 83.4±6.2%, and the local recurrence rate (LRR) was 17.8%. In well-differentiated carcinoma, 4 cases were convinced as local recurrence with a LRR of 17.4%(4/23); in moderately- differentiated carcinoma, one case with a LRR of 20.0%(1/5). The LRR in T 1 and T 2 group was 15.0% (3/20) and 25.0% (2/8) respectively. LRR was 16.7% (4/24) in patients with less than 1/3 bowel wall involved, LRR was 16.7%(4/24),whereas LRR was 25.0%(1/4) in more than 1/3 bowel wall involved group. In total bowel wall resection group the LRR was 16.7%(3/18) while in partial resection group was 20.0% (2/10). In patients with tumour size larger than 4 cm LRR was 22.2% (2/9), tumour size smaller than 4 cm LRR was 15.7% (3/19). Conclusion LE for RC might only be successfully performed in selected patients (T 1～T 2, N 0M 0, well or moderately-differentiated carcinoma,low RC within 6 cm from anal edge). The indications of transanal LE must be controlled strictly. Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence. Postoperative follow-up is needed in order to find local recurrence as early as possible.

关 键 词：直肠肿瘤 肛门 腺癌 肿瘤复发 局部切除术 

分 类 号：R735.37[医药卫生—肿瘤] R657.1[医药卫生—临床医学]