直肠类癌29例的外科治疗

目的 探讨直肠类癌的临床、病理及影响预后的因素.方法 回顾性分析两家医院29例直肠类癌患者的临床资料.所有病例均经手术和病理证实,其中内镜黏膜下切除5例,经肛门局部切除14例、局部扩大切除4例,经骶尾直肠部分切除2例,根治性切除4例.结果 本组29例直肠类癌患者的年龄32～71(54±11)岁,随访时间3至136个月,平均(61±4)个月,随访率为76%.随访期内,直径小于1 cm的13例手术切除后无复发,直径1～2 cm的5例复发1例,直径大于2 cm的4例中3例因类癌肝转移死亡.5年、10年肿瘤相关生存率为87%、80%.结论 手术治疗是直肠类癌的最佳治疗方法,手术切除范围取决于原发肿瘤的大小、浸润程度、淋巴结受累及是否存在肝脏转移等情况.

Surgical management for rectal carcinoid

Objective To investigate the clinical and pathological features of rectal carcinoid and factors influencing the prognosis. Methods Clinical data of 29 cases with postoperative pathology identified diagnosis of rectal carcinoid from May 1998 to May 2008 in the two hospitals were retrospectively reviewed. Endoscopic submucosal resection of the tumor was conducted in 5 cases,local resection in 14 cases, local expanded resection of the tumor in 4 cases, transsacral local wide resection in 2 cases, radical operation in 4 cases. Results Median age at treatment was 32～71 (54±11) years. Median follow-up was (61±4) months (3 months-10 years), follow-up rate was 76%. During a follow-up, there were no cases with recurrence among the 13 patients with tumor size<1 cm, 1 case recurred in the 5 patients with turmor size between 1 to 2 cm, and 3 cases died from postoperative liver metastasis among the 4 patients with tumor size > 2 cm. The 5-, 10-year disease-specific survival rates were 87% and 80% respectively. Conclusions Surgery is the best therapy for rectal carcinoid, the choice of operative mode must be made according to the size,infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.