局部进展期直肠癌新辅助治疗后行ISR术远切缘距离的临床研究  

A clinical study of ISR after neoadjuvant therapy for locally advanced rectal cancer

作　　者：高建新[1] 王啸飞[1] 于淼[1] 路夷平[1] Gao Jianxin;Wang Xiaofei;Yu Miao;Lu Yiping(Department of Oncology,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China)

机构地区：[1]首都医科大学附属北京中医医院肿瘤外科,北京100010

出　　处：《中华普外科手术学杂志（电子版）》2024年第5期539-543,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的:研究局部进展期直肠癌(LARC)新辅助治疗后行不同远切缘腹腔镜经括约肌间切除术(ISR)的临床效果,分析手术远切缘距离对不同病理TNM分期(ypTNM)患者预后的影响。方法:回顾性分析2019年1月至2021年12月86例接受新辅助治疗的LARC患者临床资料,所有患者经新辅助治疗后均行腹腔镜ISR手术。根据术中远切缘距离分为远切缘<1?cm组(n=38例)和≥1?cm组(n=48例)。数据应用统计软件SPSS 23.0分析,不同手术远切缘组围手术期指标、肛门功能及生活质量用(x±s)表示,组间比较采用独立样本t检验;术后并发症用[例(%)]表示,组间比较采用Fisher精确概率或χ^(2)检验;Kaplan-Meier法分析手术远切缘距离与不同病理分期亚组患者预后无病生存期(DFS)和总生存期(OS)的关系,Log-Rank检验生存差异。P<0.05为有统计学意义。结果:两组患者围手术期相关指标、术后并发症、肛门功能、生活质量及术后OS生存差异均无统计学意义(P>0.05);远切缘≥1?cm组患者术后局部复发率及累积DFS生存优于<1?cm组(P<0.05);ypT_(1)期和ypT_(2)期患者术后DFS生存与远切缘距离无关(P>0.05);ypT_(3)期远切缘<1?cm的患者DFS生存低于≥1?cm的患者(P<0.05)。结论:局部进展期直肠癌新辅助治疗后ISR手术远切缘距离的选择不影响围手术期效果、并发症的发生、术后肛门功能恢复及生活质量;手术远切缘距离<1?cm与术后局部复发和DFS生存相关,尤对ypT_(3)期患者的影响较为显著。Objective:To investigate the clinical effect of laparoscopic transsphincterectomy(ISR)with different distal incisional margins after neoadjuvant therapy for locally advanced rectal cancer(LARC),and to analyze the influence of surgical distance on the prognosis of patients with different pathological TNM stages(ypTNM).Methods:The clinical data of 86 LARC patients who received neoadjuvant therapy from January 2019 to December 2021 were retrospectively analyzed.All patients underwent laparoscopic ISR surgery after neoadjuvant therapy.According to the distance of distal incisal margin during operation,the patients were divided into the group<1?cm(n=38 cases)and the group≥1?cm(n=48 cases).Statistical software SPSS 23.0 was used to analyze the data.Perioperative indexes,anal function and quality of life of different surgical resection margin groups were represented by(x±s).Independent sample t test was used for comparison between groups.Postoperative complications were represented by[cases(%)],and Fisher exact probability orχ^(2) test was used for comparison between groups.Kaplan-Meier method was used to analyze the relationship between surgical resection margin distance and disease-free survival(DFS)and overall survival(OS)of patients in different pathological stage subgroups,and the survival difference was tested by Log-Rank.P<0.05 was considered statistically significant.Results:There were no significant differences in perioperative parameters,postoperative complications,anal function,quality of life and OS survival between the two groups(P>0.05).The postoperative local recurrence rate and cumulative DFS survival in patients with distal resection margin≥1?cm were better than those in<1?cm group(P<0.05).The postoperative DFS survival of ypT_(1) and ypT_(2) patients was not correlated with the distance of distal incisal margin(P>0.05).DFS survival in patients with distal resection margin<1?cm at ypT_(3) stage was lower than that in patients with distal resection margin≥1?cm(P<0.05).Conclusion:After neoadjuvant

关 键 词：直肠肿瘤 新辅助治疗 经括约肌间切除术 切缘 肿瘤复发 局部 

分 类 号：R735.3[医药卫生—肿瘤]