影响直肠癌局部切除术的抉择因素

0引言直肠癌前切除术(anterior resection)和腹会阴联合切除术(abdominoperineal resection,APR)是目前最常用的直肠癌手术术式[1-2]。直肠癌的根治性手术可将直肠肿瘤整块切除,并清扫可能存在肿瘤转移的区域淋巴结,但此类根治性手术仍伴随着较高的并发症发生率,比如吻合口瘘、盆腔感染、排便功能异常、膀     

经肛门直肠癌局部切除术11例分析

我院 1995年 1月至 2 0 0 0年 12月共施行经肛门直肠癌局部切除术 11例 ,临床疗效满意 ,现报告如下。1　临床资料1.1　一般资料本组 11例中 ,男性 4例 ,女性 7例 ;年龄 35～ 78岁 ,平均年龄 5 8岁 ,其中 60岁以上者 6例。伴发病 :严重慢性支气管炎、肺气肿、肺源性心脏病 1例 ,肺结核 1例。直肠下段原发癌 8例 ,直肠癌经腹前切除术后直肠残端复发癌 3例。肿瘤部位 :位于直肠后壁 7例 ,侧壁 3例 ,前壁 1例。肿瘤距肛缘 6ｃｍ 4例 ,5ｃｍ 5例 ,4ｃｍ 1例 ,3ｃｍ 1例。病理类型 :根据文献[1,2 ] 将本组11例直肠癌分为隆起型和盘状型。其中隆起…     

早期直肠癌的局部切除治疗现状

早期直肠癌选择局部切除治疗，有２％－１８％的淋巴结转移的潜在危险，直接影响病人的预后。能否有效地降低这种危险，使病例选择更加合理，手术前更加准确的评估就显得尤为重要。本文就的年来在此方面的研究及局部切除后的疗效作一综述。     

低位直肠腺癌局部切除术

自１９８９年—１９９４年间,我们共对１５例低位直肠腺癌行局部切除术,现结合临床及术后随访资料,对该术式进行分析。作者单位：广州市第十二人民医院５１０４０５广州市广园中路景泰直街３５号１临床资料在１５例直肠癌患者中,男性１０例,女性５例;年龄４０岁～７...     

Mason手术在中下段直肠癌局部切除术中的应用价值

目的探讨Mason手术在中下段直肠癌局部切除术中的应用价值.方法对本院近14年来采用Mason手术作局部切除的54例中下段直肠癌病例进行回顾性分析.结果Tis期癌17例,T1期癌20例,T2期癌15例,T3期癌2例.所有标本切缘经病理检查未发现癌残留.平均随访期为66个月.5年存活率为95%.术后局部复发1例(1.9%).术后无肛门失禁发生,伤口感染和直肠皮肤瘘各2例(3.7%).结论Mason手术是中下段直肠癌局部切除术的理想术式.术前高质量的肠道清洁准备,术中正确处理肛门外括约肌的切断与修复,完整彻底地切除肿瘤,是该手术成功的关键.     

经腹直肠癌切除保留肛门结肠拉出术(附19例)

我院从 1996年 3月至 2 0 0 1年 5月 ,经腹行直肠癌切除保留肛门结肠拉出术共 19例 ,现报告如下。1　资料和方法1.1　一般资料　男 11例 ,女 8例。年龄 4 1岁～ 75岁 ,平均年龄 5 2 5岁。直肠癌的病灶下缘距肛缘 5～ 8cm ,组织类型 :高分化腺癌 7例 ,中分化腺癌 9例 ,低分化腺癌l例 ,粘液腺癌 2例。l 2手术方法　取截石位 ,下腹左旁边正中切口 ,开腹探查后 ,对可以根治者 ,在乙状结肠下 1/ 3段结扎肠管 ,阻断肠腔 ,并向肿瘤肠腔内注入 5 -Ful0 0 0mg。先结扎切断直肠上动、静脉。清除淋巴结方法、范围及游离直肠同Miles’手术 ,但向下游离…     

经肛门内镜微创手术治疗直肠肿瘤的临床研究进展

临床外科治疗直肠肿瘤的主要方法是局部肿瘤切除术。经肛门内镜微创手术（TEM）是腹腔镜和内镜相结合的微创手术术式,是直肠肿瘤局部切除手术方式中的一种。TEM的适应证包括直肠腺瘤、直肠息肉等良性病变及T1期直肠癌（未发生淋巴结转移）。此外,临床正在积极开展关于术前新辅助放化疗联合TEM治疗直肠癌的系列研究。但目前应用TEM治疗更高级别的直肠癌仍存在一定的争议。应用TEM对直肠癌的病变部位进行全层切除后,可在内镜直视下缝合缺损,降低手术导致的损伤及术后并发症发生率。因此,TEM对直肠癌进行局部切除仍具有一定的临床优势。本文对TEM治疗直肠肿瘤的研究进展进行综述。     

108例Tis~1N0M0期中低位直肠癌经肛门局部切除的临床评价

[目的]探讨Tis~1N0M0期中低位直肠癌经肛门局部切除的合理性。[方法]回顾性分析经肛门局部切除治疗的108例Tis~1N0M0期中低位直肠癌患者的资料。其中TisN0M063例,T1N0M045例。8例T1期患者接受了术后辅助放疗。[结果]所有患者术后恢复顺利,中位住院时间5d(3~8d)。无吻合口漏、直肠狭窄、肛瘘及其他手术并发症。术后肛门括约肌功能良好。5年总生存率为99.07%,Tis、T1期5年生存率分别为100%和97.78%。5年总复发率为1.85%,Tis、T1期5年复发率分别为0、4.44%。[结论]对Tis~1N0M0期中低位直肠癌患者,经肛门局部切除术既保证了生存率,又兼顾了患者的生存质量,为一种较为理想的术式选择。     

直肠癌保留肛门术后局部复发原因及外科处理

Of seventy-one patients with rectal cancer after radical resection retaining the anus, 15 developed local recurrence with a recurrence rate of 21.1%. Local recurrence was correlated with improper safety margin from the lower edge of cancer to the anal end. There was statistical significant difference between 3 cm or more and 2 cm or less. The local recurrence was also related to the pathologic stage, histologic differentiation and implant of free cancer cells. It is suggested that the surgical indication of saving the anus be strict and without stretching, the safety margin from the lower edge of cancer to the anal end should not be less than 2 cm in early rectal cancer and not less than 4 cm in advanced lesions. During the operation, no touching tumor technique, thorough rinsing of the peritoneal cavity and pre- or post-operative radiotherapy are important for prevention of local recurrence. Early local recurrent rectal cancer can be detected by periodic examinations.     

Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond

The goal of treatment for early stage rectal cancer is to optimize oncologic control while minimizing the long-term impact of treatment on quality of life. The standard of care treatment for most stage I and II rectal cancers is radical surgery alone, specifically total mesorectal excision (TME). For early rectal cancers, this procedure is usually curative but can have a substantial impact on quality of life, including the possibility of permanent colostomy and the potential for short and long-term bowel, bladder, and sexual dysfunction. Given the morbidity associated with radical surgery, alternative approaches to management of early rectal cancer have been explored, including local excision (LE) via transanal excision (TAE) or transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS). Compared to the gold standard of radical surgery, local procedures for strictly selected early rectal cancers should lead to identical oncological results and even better outcomes regarding morbidity, mortality, and quality of life.     

直肠系膜全切除在直肠根治术中的地位

Objective To evaluate the effect of total mesorectal excision (TME) on local recurrence rate and 5-year survival rate following radical resection for rectal cancer. Methods From Jan. 1991 to Dec. 1998, 746 cases of rectal cancer treated with radical resection were divided randomly into group B (341 cases) undergoing traditional procedures and group A (405 cases) undergoing TME. There was no significant difference in tumor location, morphological appearance, histological patterns, grade of differentiation and staging clssification between two groups. SSR was carried out in 65.25% cases of group A and 54.25% cases in group B (P<0.05). Results Operative death occurred in 9 cases with an operative mortality rate being 0.97%, 5 cases in group A and 4 cases in group B. Anastomotic leakage occurred in 19 cases with an occurrence rate being 4.21%, 8 in group A (3.95%) and 11 cases in group B (5.95%). The follow-up rate in this series was 91% with the follow-up duration from 2 to 9 years, mean 48.3 months. Local recurrence occurred in 47 cases with an overall recurrence rate being 6.30%, 16 cases in group A (3.95%) and 31 in group B (9.09%),P<0.01. The overall 5-year survival rate was 72.46%±3.84% (life table method), 78.58%±3.28% in group A and 67.86%±3.02% in group B, respectively,P<0.05. Conclusion Radical resection with TME can effectively reduce the local recurrence tate and significantly improve 5-year survival rate as compared with traditional procedures.     

早期中低位直肠癌经肛门切除的疗效分析

目的:探讨早期中低位直肠癌经肛门局部切除术的临床应用价值。方法:回顾性分析2012年至2015年期间我院收治的112例早期中低位直肠癌患者,分为经肛门局部切除组（n=52）和根治性切除组（n=60）。术后标本行常规免疫组化病理检测,同时对比两组患者的各种临床病理特征。结果:两组患者肿瘤大小、肿瘤距肛缘距离比较差异无统计学意义（P＞0.05）;术后住院天数、术中出血量、术后并发症发生率及手术时间比较差异有统计学意义（P＜0.05）。结论:早期中低位直肠癌经肛门切除与根治性手术比较治疗效果相当,但操作更简便易行,创伤小,恢复快、并发症少、术后生活质量高,具有一定优势,特别是内镜切割吻合器的联合应用,使得该术式更简便易行,在具有适应征患者中可以推广。     

Implications for selecting local excision in locally advanced rectal cancer after preoperative chemoradiation

Local excision may offer the possibility of organ preservation for the management of locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT). However, the oncological outcomes of this strategy have been largely associated with the risk of nodal metastases. In this study, Surveillance, Epidemiology, and End Results Program (SEER)-registered rectal cancer patients, and patients from Fudan University Shanghai Cancer Center (FUSCC) after preoperative chemoradiation were combined to analyze the incidence of lymph node metastasis. The results showed that there was a high risk for residual lymph node metastasis among patients even with complete pathologic response of primary tumor after preoperative CRT (12.6–13.2%). However, in the selected group of patients with pre-CRT MRI staging cN0 rectal cancer, there was only one ypN+ case (3.3%) in ypT0–1 group. These results suggest that pre-CRT MRI staging cN0 patients achieved ypT0–1 of bowel wall tumor may be suitable for local resection.     

Surgical outcomes after total mesorectal excision for rectal cancer

BACKGROUND AND OBJECTIVES: This study reviewed the results of surgery for distal rectal cancer following the introduction of total mesorectal excision (TME) for rectal cancer. METHODS: Two hundred sixty-four patients who had undergone elective curative surgical resection of rectal cancer within 12 cm of the anal verge were included. Comparisons were made between patients who had different surgical procedures. RESULTS: The overall operative mortality rate was nil, and the morbidity 39.4%. With a mean follow-up of 34 months (range 5-105 months), local recurrence occurred in 21 of the patients. The 3- and 5-year actuarial local recurrence rates were 9% and 12%, respectively for the whole group. Abdominoperineal resection (APR) was necessary in 65 of 264 (24.6%) of the patients, with a very low local recurrence rate in this subgroup (5% at 3 years). On multivariate analysis, only stage was a significant prognosticator of overall survival (P = 0.012). CONCLUSIONS: With the practice of TME, APR was still necessary in 25% of patients with rectal cancer within 12 cm of the anal verge. Type of surgery and tumor distance from the anal verge influenced local recurrence rates, but only initial tumor stage was associated with long-term survival.     

Total mesorectal excision and management of rectal cancer

Treatment of rectal cancer over the last two decades has evolved with changes in techniques of surgery and radiation based on national and international trials. Preoperative adjuvant radiation is now preferred over postoperative adjuvant radiation, and total mesorectal excision with preservation of pelvic nerves is the gold standard for surgical treatment of rectal cancer. Preservation of the anal sphincter without compromising oncological outcome is an additional benefit for patients with carcinoma in the distal rectum. Further progress in imaging and a multidisciplinary team approach will facilitate individualization of treatment strategy with more focus on quality of life.     

局部切除治疗早期直肠癌

１９８４年９月～１９９４年９月，作者应用局部切除术治疗组织学特征良好的Ｔ＿１～Ｔ２Ｎ０Ｍ０期直肠癌２４例，结果５年无瘤存活率和局部控制率均为９５．８％。１例早期病例于术后１年半局部复发，无手术死亡及并发症。我们认为对癌细胞高度或中度分化，无淋巴管或静脉受侵犯，距肛缘１１ｃｍ之内，局限于粘膜或粘膜下层，或侵犯到肌层但未穿透肌层者均可行局部切除术。     

低位直肠癌经肛提肌外腹会阴联合切除术的研究进展

目的 肛提肌外腹会阴联合切除术(exralevator abdominoperineal excision,ELAPE)的提出旨在改善低位直肠癌的手术安全性和肿瘤预后,但其应用仍存在争议.本研究总结ELAPE治疗低位直肠癌的最新研究进展.方法 应用PubMed及CNKI期刊全文数据库检索系统,以"肛提肌外、腹会阴联合切除术和低位直肠癌"为关键词,检索2006-01-2015-12的相关文献.纳入标准:(1)ELAPE的疗效分析;(2)ELAPE术后并发症的处理;(3)ELAPE的适用范围;(4)ELAPE体位的选择.排除标准:(1)综述和会议汇编等相关文献;(2)实验设计不严谨.根据纳入和排除标准,符合分析53篇,其中英文文献45篇,中文文献8篇.结果手术是低位直肠癌的首选治疗方案,ELAPE作为治疗低位直肠癌新的术式,目前其手术体位,术后盆底重建,手术疗效及适用范围等方面存在诸多争议,仍需要进一步探讨,尤其是手术疗效及患者术后生活质量亟需进一步的前瞻性研究来验证.结论ELAPE尚不能取代传统腹会阴联合切除术(abdominoperinealexcision,APE)而成为治疗低位直肠癌的标准术式,ELAPE术式可能还需要进一步优化和改进.