中国taTME病例登记协作研究数据库中直肠癌经括约肌间切除术标本质量分析:一项全国性登记研究  

Analysis of specimen quality of intersphincteric resection for rectal cancer in the Chinese Transanal Total Mesorectal Excision Registry Collaborative database:a nationwide registered study

作　　者：魏鹏宇 任明扬[2] 王权[3] 张宏[4] 陈建志 徐庆[6] 肖毅[7] 马丹 傅志聪 熊德海 李杨[1] 姚宏伟[1] 张忠涛[1] Wei Pengyu;Ren Mingyang;Wang Quan;Zhang Hong;Chen Chienchih;Xu Qing;Xiao Yi;Ma Dan;Fu Zhicong;Xiong Dehai;Li Yang;Yao Hongwei;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,State Key Laboratory of Digestive Health,National Clinical Research Center for Digestive Diseases,Capital Medical University,Beijing 100050,China;Department of Gastrointestinal Surgery,Nanchong Central Hospital,North Sichuan Medical College,Nanchong 637900,China;Department of Gastrointestinal Surgery,The First Hospital of Jilin University,Changchun 130021,China;Department of Colorectal Oncology Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Division of Colorectal Surgery,Koo Foundation Sun Yat-Sen Cancer Center,Taipei 112019,China;Department of Gastrointestinal Surgery,Renji Hospital Afiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China;Department of General Surgery,Second Affiliated Hospital of Army Military Medical University,Chongqing 400037,China;Department of Colorectal Surgery,The University of Hong Kong-Queen Mary Hospital,Hongkong 999077,China;Department of Gastrointestinal Surgery,Chongqing University Three Gorges Hospital,Chongqing 404000,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科、消化健康全国重点实验室、国家消化系统疾病临床医学研究中心,北京100050 [2]川北医学院南充中心医院胃肠外科,南充637900 [3]吉林大学第一医院胃肠外科,长春130021 [4]中国医科大学附属盛京医院结直肠肿瘤外科,沈阳110004 [5]台北和信治癌中心医院结直肠外科,台北112019 [6]上海交通大学医学院附属仁济医院胃肠外科,上海200127 [7]北京协和医院基本外科,北京100730 [8]陆军军医大学第二附属医院普通外科,重庆400037 [9]香港大学玛丽医院外科,中国香港999077 [10]重庆大学附属三峡医院胃肠外科,重庆404000

出　　处：《中华消化外科杂志》2024年第6期819-825,共7页Chinese Journal of Digestive Surgery

基　　金：国家重点研发计划(2017YFC0110904);北京市临床重点专科基金(2018-118);首都医科大学结直肠肿瘤临床诊疗与研究中心专项基金(1192070313);北京市医院管理中心扬帆计划临床技术创新项目基金(ZLRK202302)。

摘　　要：目的探讨中国经肛全直肠系膜切除术病例登记协作研究(CTRC)数据库中直肠癌经腹经肛混合入路括约肌间切除术(ISR)标本质量。方法采用回顾性病例对照研究方法。基于真实世界研究理念,收集2017年11月15日至2023年12月31日CTRC数据库中首都医科大学附属北京友谊医院等19家医学中心收治的281例直肠癌行经腹经肛混合入路ISR患者的临床病理资料;男196例,女85例;年龄为61(27~87)岁。观察指标:(1)术前检查情况;(2)新辅助治疗情况;(3)术后检查情况;(4)直肠癌ISR标本环周切缘阳性的影响因素分析。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。单因素分析采用χ^(2)检验。多因素分析采用Logistic回归模型。结果(1)术前检查情况。281例患者中,234例行术前盆腔磁共振成像(MRI)检查,其中临床T0期2例、T1期3例、T2期58例、T3期137例、T4期24例、Tx期3例,数据缺失7例;临床N0期87例、N1期68例、N2期60例、Nx期9例,数据缺失10例;30例直肠系膜筋膜阳性;53例壁外血管侵犯阳性;肿瘤下缘距肛缘距离为41.9(1.0~80.0)mm。(2)新辅助治疗情况。281例患者中,125例行新辅助治疗,其中单纯化疗39例、短程同步放化疗6例、短程同步放化疗+延迟手术5例、长程同步放化疗48例、其他方案2例,数据缺失25例。(3)术后检查情况。281例患者中,R_(0)切除、R_(1)切除分别为249、9例,数据缺失23例;肿瘤最大径为30.0(0.5~200.0)mm,获取淋巴结数目为13(0~70)枚,脉管内瘤栓阳性率为27.55%(73/265);252例记录环周切缘情况,环周切缘阳性15例,切缘阳性率为5.95%(15/252),肿瘤深部距环周切缘最小距离为7.0(0~150.0)mm;85例记录远端切缘情况,远端切缘阳性1例,肿瘤下缘距远端切缘距离为10.0(0~202.0)mm;273例记录标本完整性情况,标本质量完好、一般、不佳、未评估分别为208、58、4、3例;7例发生肠�Objective To investigate the specimen quality of intersphincteric resection with transabdominal transanal mixed approach for rectal cancer in the Chinese Transanal Total Mesorectal Excision Registry Collaborative(CTRC)database.Methods The retrospective case-control study was conducted.Based on the concept of real-world research,the clinicopathological data of 281 patients with rectal cancer in the CTRC database who underwent intersphincteric resection with trans-abdominal transanal mixed approach in 19 medical centers,including the Beijing Friendship Hospital of Capital Medical University etal,from November 15,2017 to December 31,2023 were collected.There were 196 males and 85 females,aged 61(range,27-87)years.Observation indicators:(1)preoperative examinations;(2)neoadjuvant therapy;(3)postoperative examinations;(4)analysis of influencing factors for positive circumferential margin in surgical specimen of intersphincteric resec-tion for rectal cancer.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages.The chi-square test was used for univariate analysis.Logistic regression model was used for multivariate analysis.Results(1)Preoperative examinations.Of the 281 patients,234 cases underwent preoperative pelvic magnetic resonance imaging(MRI)examina-tion.There were 2 cases in clinical stage T0,3 cases in clinical stage T1,58 cases in clinical stage T2,137 cases in clinical stage T3,24 cases in clinical stage T4,3 cases in clinical stage Tx,7 cases missing clinical T staging data.There were 87 cases in clinical stage N0,68 cases in clinical stage N1,60 cases in clinical stage N2,9 cases in clinical stage Nx,10 cases missing clinical N staging data.There were 30 cases with mesorectal fascia invasion,53 cases with extramural venous invasion.The distance from lower margin of tumor to anal margin was 41.9(range,1.0-80.0)mm.(2)Neoadjuvant therapy.Of the 281 patients,125 cas

关 键 词：直肠肿瘤 低位 经括约肌间切除术 手术标本 环周切缘 

分 类 号：R735.37[医药卫生—肿瘤]