摘要
目的探讨经肛门内镜显微手术(TEM)局部切除早期直肠癌后续治疗方式的选择。方法回顾性分析北京协和医院于2013—2019年间收治的105例经TEM切除直肠癌病人资料,所有病人均在知情同意后接受TEM。结果105例病人经术前检查[直肠腔内超声和(或)直肠MRI]评估为cT1期且除外淋巴结转移,经病理学活检报告为腺瘤局部癌变或者直肠腺癌,均通过TEM完成直肠癌的局部扩大切除。105例病人术后36例行补救性根治性手术,29例行补救性放化疗,40例仅随访观察。105病人术后接受平均40(12~69)个月随访。随访期间,13例(12.4%)局部复发,2例(1.9%)远处转移,3例(2.9%)死亡。单因素分析结果显示,T分期(P=0.003)、是否R0切除(P<0.01)和术后处理策略(P=0.036)是复发及死亡预测因子。在多因素分析中,T分期(HR 7.36,95%CI1.82~29.85,P=0.005)、是否R0切除(HR 20.82,95%CI 2.71~159.64,P=0.003)及术后处理策略(HR 0.57,95%CI0.08~0.38,P=0.003)与复发及死亡密切相关。结论TEM局部切除pT1期直肠癌安全、有效。而对于pT2期或未达R0切除直肠癌病人术后复发风险高,后续积极采取根治术或辅助放化疗的补救性治疗可提高病人预后。
Objective Explore the remedial treatments after the selection of transanal endoscopic microsurgery(TEM)for early rectal cancer.MethodsA retrospective study was conducted on the clinical data of early-stage rectal cancer patients admitted to Peking Union Medical College Hospital from 2013 to 2019 who underwent TEM surgery.All patients received informed consent.ResultsAll 105 patients underwent local enlarged resection of rectal cancer by TEM.Of the105 patients,36 underwent salvage radical surgery,29 underwent salvage chemoradiotherapy,and 40 were selected to be in followed up.All patients were followed up for an average of 40 months(12 to 69 months).During the stage of follow-up,13 patients(12.4%)occurred local recurrence,2(1.9%)suffered from distant metastasis,and 3(2.9%)died.In univariate analysis,T staging(P=0.003),R0 resection(P<0.01)and postoperative management strategy(P=0.036)were predictors of recurrence and death.In the multivariate analysis,T staging(HR 7.36,95%CI 1.82—29.85,P=0.005),R0 resection(HR 20.82,95%CI 2.71—159.64,P=0.003)and postoperative management strategy(HR 0.57,95%CI 0.08—0.38,P=0.003)were closely related to recurrence and death.Conclusion TEM is a safe and effective way for pT1 stage,T2 stage and the absence of R0 resection are high risk factors of recurrence,and salvage radical resection or adjuvant chemoradiotherapy can improve the prognosis.
作者
白雪杉
李昀昊
林国乐
周皎琳
牛备战
邱辉忠
BAI Xue-sha;LI Yun-hao;LIN Guo-le(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第3期346-352,共7页
Chinese Journal of Practical Surgery
基金
北京市科技重大专项基金(No.D171100002617003)
