局部切除术在早期低位直肠癌中应用.docVIP

局部切除术在早期低位直肠癌中应用 　 作者：吕强，冯国光，恽蓓，杨志强 【摘要】 目的 局部切除术治疗早期低位直肠癌指征探讨和疗效评估。方法 回顾性分析42例经局部切除术治疗和病理证实的早期低位直肠癌患者临床资料。结果 42例早期低位直肠癌均为局部肿瘤根治性切除。无手术死亡病例。无严重术后并发症。获随访39例（92.86%）。39例早期癌中36例（92.31%）术后生存＞5年，2例术后3～4年、1例1.5年至今仍健在。总的局部复发率为9.52%（4/42），复发距手术间隔期为1.5～2年；其中再次行Dixon术2例，改良Bacon术1例，局部扩大全层切除术1例。结论 对经仔细选择的早期低位直肠癌局部切除术是一种安全而有效的治疗方法。 　　【关键词】 直肠癌；局部切除术 　　Local excision in early low rectal cancer 　　【Abstract】 Objective To discuss the indication and to evaluate the effectiveness of local tumor excision for the treatment of early low rectal cancer.Methods The clinical data of 42 patients with early low rectal cancer resected by operation and confirmed by pathology were retrospectively analysed.Results There were 29 males and 13 females in all patients with early low rectal cancer.The median age was 53 years (range,25～79 years).42 patients with early low rectal cancer were treated by local tumor excision for curative intern,no patients died and no severe complication occured in this technique 39 (92.86%) patients of whom were followed up carefully.Among them,36 patients existed for over 5 years and 3 patients remain alive at 3～4 years (2 cases) and 1.5 years (1 case) after operation.4 (9.52%) patients developed local recurrences at 1.5～2 years after operation,in 42 patients.Dixons operation was again performed in 2 cases,modified Bacons operation in 1 case,local excision once again in 1 case.Conclusion Local tumor excision is a safe and effective precedure for the treatment of carefully selected early low rectal cancer. 　　【Key words】 rectal cancer；local excision 　　直肠癌是常见恶性肿瘤之一。我国直肠癌好发于腹膜反折以下的低位，约占75%。传统的治疗方法是直肠经腹前切除术或经腹会阴联合切除术。近年来局部切除术治疗低位直肠癌日益受到人们重视。笔者回顾性分析了42例经局部切除术治疗和病理证实的早期低位直肠癌临床资料，对局部切除术的临床应用指征进行探讨，并对疗效做一评估，现报告如下。 　　1 临床资料 　　自1985年6月～2005年5月上海公利医院和瑞金医院共行局部切除术治疗42例早期低位直肠癌，材料均经病理检查证实，其中男29例，女13例，年龄25～79岁，平均（53±2）岁。肿瘤距肛缘6～7cm 7例，5～6cm 12 例，4～5cm 16例，＜4cm 7例。肿瘤直径：超过2～3cm 12例，1～2cm 17例，＜1cm 13例。肿瘤大体类型：肿块型39例，溃疡型2例，浸润型1例；组织学分类：腺癌39例，黏液癌2例，鳞癌1例；恶性度（Broders法分级）：Ⅰ级36例，Ⅱ级6例。Dukes中国改良法分期：