低位直肠癌局部切除术疗效分析

目的：探讨局部切除术治疗直肠癌的临床应用指征和疗效。方法：回顾性分析1996～2002年我院行局部切除术治疗42例中低位直肠癌病人的治疗情况及随诊资料。结果：42例中有Tis期6例，T1期20例，T2期16例。围手术期死亡率为零，无严重术后并发症。随访中7例（16．7％）局部复发，包括T1期2例和T2期5例。χ^2检验显示，肿瘤大体类型、肿瘤直径、T分期与术后复发相关（P〈0．05）。本组总体5年生存率为83．3％，Tis、T1、T2期病变分别为100％、90．0％、68．8％。结论：早期（Tis、T1期）高中分化癌、具良好的生物学特性及无淋巴、血管浸润的直肠癌行局部切除术可作为有效的治疗方案。T2期及以上的肿瘤应首选根治性手术。对不能忍受根治术者或拒行腹壁人工肛门者，无耐时，可考虑行姑息性局部切除术后加行辅助放、化疗。

Efficacy of local resection for lower rectal cancer

Objective To evaluate the feasibility and efficacy of local resection for lower rectal cancer.Methods The clinical data from 42 patients with lower rectal cancer,admitted during the period 1996-2002,were retrospectively analyzed.Results Among these 42 patients,6 belonged to Tis,20 to T1,and the other 16 to T2.No perioperative mortality and severe complications were observed.Seven cases(16.7%) developed local recurrence,among which 2 belonged to stage T1 lesion,and 5 to stage T2.Gross classification,tumor size,T staging were closely related to the risk of local recurrence(P<0.05).The overall 5-year survival rate was 83.3%.The survival rates in Tis,T1,and T2 tumors were 100%,90.0% and 68.8%,respectively.Conclusions Local resection is an acceptable option for well-differentiated,LN-negative early rectal cancer cases with good biological behavior.Radical resection should be considered for T2 lesions.Palliative local resection combined with adjuvant chemoradiotherapy should be reserved for patients who are unable to tolerate radical operation or refuse to accept colostomy.