摘要
目的:评估经肛门内镜显微手术(TEM)在pT1直肠癌局部切除中的临床应用价值。方法:对2006-06-2010-06山东省千佛山医院胃肠外科收治的50例pT1直肠癌TEM患者的临床资料进行回顾性分析。结果:全部患者中初始黏膜下切除12例(术前为uT0期),切缘阳性4例(行扩大性全层切除后切缘均显示阴性);全层切除38例(uT1或uT2期),所获标本切缘均阴性。术中失血(15.5±10.5)mL,住院时间(4.5±3.2)d。12例患者(24.0%)出现经肛局部切除相对特异性轻度并发症;术后1个月时患者原有排便习惯与粪便性状改变症状均趋消失。随访期内局部复发2例(4.0%),患者经相应补救性处理后效果良好;未见肿瘤远处转移及死亡患者。多因素分析显示,肿瘤浸润深度肿瘤累及黏膜下全层(Sm3)和肠壁受累范围(>半周)是pT1直肠癌TEM术后复发的独立危险因素。结论:pT1期直肠癌TEM超黏膜下层切除是完全可行的,但Sm3浸润、肠壁受累超过半周及瘤径偏大(>3cm)的T1直肠癌TEM后复发风险增加;术后并发症轻,以直肠刺激症状为主,相关变化于术后1个月时趋于消散。
OBJECTIVE： To further evaluate the clinical application and effectiveness of transanal endoscopic microsurgery（TEM） in the local resection for pT1 rectal cancer. METHODS： A retrospective analysis was given to the correla- tive clinicopathologic data of 50 cases with T1 rectal cancers treated by TEM between June 2006 and June 2010 in the de- partment of gastrointestinal surgery of Provincial Qian Foshan Hospital. RESULTS Twelve cases with uT0 staging rectal cancer underwent the preliminary submucosal resection with the positive resected margins in 4 cases who immediately received the extensive full-thickness excision, and the other 38 cases with uT1 or uT2 staging lesions received direct full- thickness excision with no positive resected margin. The intraoperative blood loss was （15.5 ± 10.5） mL and the average hospital stay was （4.5±3.2） d. The relatively specific mild complications of transanal local resection occurred in 12 cases （24.0%） while the patients,previous changes in bowel habits and excrement properties tended to disappear one month after TEM. Local recurrence occurred in 2 cases（4.0%） who received the subsequent salvage treatments with good effectiveness and there was no distant metastasis or death during follow-up. Multivariate analysis showed that depth of invasion （Sm3） and circumferential extent of bowel wall（more than semicircumference） were independent risk factors for pT1 rectal cancer recurrence after TEM. CONCLUSIONS： The exceeding submucosal resection of pT1 rectal caner by TEM is reasonable and feasible. The postoperative complications consisting chiefly of rectal irritation symptoms are mild and tend to disappear one month after TEM. The therapeutic effectiveness of local resection for T1 rectal cancer by TEM is generally fine. However the recurrence risk of T1 lesions with Sm3 invasion, more than semicircumference of bowel wall involvement or larger than 3 cm in diameter was increased after TEM.
出处
《中华肿瘤防治杂志》
CAS
北大核心
2013年第9期695-698,共4页
Chinese Journal of Cancer Prevention and Treatment
关键词
直肠肿瘤
外科学
内镜显微手术
复发
治疗结果
rectal neoplasms
endoscopic microsurgery
recurrence
treatment outcome
