低位直肠肿瘤经肛门局部切除临床研究

目的探讨经肛门局部切除低位直肠良恶性肿瘤的效果和预后。方法回顾性分析北京大学临床肿瘤医院胃肠外科2000年1月—2006年2月经肛门局部切除的并获得随访的62例低位直肠肿瘤临床资料,评价其治疗效果及预后。结果62例患者中,良性45例,恶性17例。腺瘤43例,腺癌15例,类癌1例,间质瘤1例及其他2例。肿瘤直径3 cm40例,有2例(5%)复发;肿瘤直径≥3 cm 22例,有6例(27%)复发。2者比较有显著性差异(P0.05)。腺癌病例中,13例T1期直肠腺癌,其中1例(8%)局部复发;2例为T2期直肠腺癌,均有局部复发。2者复发率比较有显著性差异(P0.05)。肿瘤距肛缘2~10 cm,距肛缘≤5 cm 45例,其中有3例(7%)复发;5 cm 17例,其中有5例(29%)复发。2者复发率比较有显著性差异(P0.05)。结论经肛门局部切除低位直肠肿瘤手术具有低并发症和肠道功能恢复快的优点,适用于治疗良性和早期恶性肿瘤的治疗。选择合适的患者进行局部治疗是保证疗效的关键。

Research for trans-anal local excision of lower rectal tumors

Objective It is to approach the effect and prognosis of trans-anal local excision in the treatment of patients with benign and malignant lower rectal tumors.Methods The clinical data of 62 patients with lower rectal tumor were retrospective analyzed,who were treated by trans-anal local excision in Clinical Oncology Gastrointestinal Surgery of Peking University Hospital from January 2000 to December 2006 and were followed up,and the effect and prognosis were evaluated.Results Among 62 patients,there were 15 cases of adenocarcinoma,43 cases of adenoma,1 case of carcinoid,1 case of GIST,and 2 cases of others.There were 40 patients with the tumor size <3 cm,included 2 cases with tumor recurrence; 22 patients with the tumor size ≥3 cm,included 6 cases with tumor recurrence.There was significant difference in the relapse rate in them(P<0.05).Among the patients of adenocarcinoma,there were 13 cases(87%) in T1 and 2 cases(13%) in T2.The tumor recurrence was observed in 1 of 13 patients for T1(8%) and in 2 of 2 patients for T2(100%)(P<0.05).All tumors located 2 to 10 cm from the anal verge,there were 45 cases with tumor ≤5 cm away from anal verges,among which 3 cases had recurrences(7%);17 cases with tumor >5 cm away from anal verges, among which 5 cases had recurrences(29%).There was significant difference in the relapse rate in them(P<0.05).Conclusion Trans-anal local excision for lower rectal tumor is beneficial for its less morbidity and faster recovery of intestinal functions.It is propitious to the curative management of benign rectal tumors and early malignant neoplasm. It is crucial to apply this method to the suitable patients and operate local treatment to ensure the curing effect.