摘要
目的探讨Ⅰ期低位直肠癌局部切除术临床应用的合理性。方法回顾性分析93例I期（T1-2N0M0）低位直肠癌患者的资料。按手术方式不同分为：局部切除术组（45例）和根治术组（48例）。局部切除术组均行经肛门局部切除术，术后T1期（24仞）行辅助放疗，T2期（21例）行辅助放、化疗。根治术组（T，期18例，T2期30例）均行根治术（行腹会阴联合切除术42例，低位前切除术6例），术后未行放、化疗。所有患者均随访5年以上。对两组患者的生存率、复发率、并发症发生率进行比较分析。结果（1）局部切除术组和根治术组5年生存率T1期均为100％（24／24，18／18），T2期分别为86％（18／21）和93％（28／30），两组比较差异无统计学意义（P〉0．05）。（2）局部切除术组和根治术组5年复发率T1期分别为4％（1／24）和0（0／18），T2期分别为19％（4／21）和7％（2／30），两组比较差异无统计学意义（P〉0．05）。（3）局部切除术组并发症发生率为2％（1／45），根治术组为15％（7／48），前者显著低于后者（P〈0．05）。结论对于Ⅰ期低位直肠癌，经肛门局部切除术联合术后放、化疗可获得与根治术相近的5年生存率，是一种合理的治疗方式。
Objective To assess the validity of transanal local excision for stage Ⅰ low rectal carcinoma. Methods The clinical data of 93 patients with stage Ⅰ low rectal carcinoma who underwent transanal excision （group A, n =45） or radical resection （group B, n =48） were retrospectively analyzed. Twenty-four T1 patients and 21 T2 patients in group A received postoperative adjuvant radiation therapy and adjuvant chemoradiotherapy, respectively. All patients in group B received radical surgery only. The J-year survival rates, recurrence rates, and postoperative complications between the 2 groups were compared. Results The J-year survival rates were 100% （24/24） for T1 patients, 86% （18/21） for T2 patients in group A, and 100% （18/18） for T1 patients, 93% （28/30） for T2 patients in group B, with no significantly statistical difference between the 2 groups （ P 〉0.05）. The recurrence rates were 4% （1/24） for T1 patients, 19% （4/21） for T2 patients in group A, and 0 （0/18） for T1 patients, 7% （2/30） for T2 patients in group B, with no significance between the 2 groups （ P 〉0.05）. The incidence of postoperative complications in group A was 2% （ 1/45）, which was significantly lower than that of 15% （7/48）） in group B （ P 〈 0.05 ）. Conclusions Transanal local excision of early low rectal carcinoma, combined with postoperative chemotherapy for T1 patients or chemoradiotherapy for T2 patients, results in a low complication rate and good sphincter function, and provides satisfactory local control and 5-year survival rates.
出处
《中华消化外科杂志》
CAS
CSCD
2008年第2期144-146,共3页
Chinese Journal of Digestive Surgery
关键词
直肠肿瘤
局部切除
Rectal neoplasms
Local excision
