经肛门局部切除术治疗Ⅰ期低位直肠癌

目的 探讨Ⅰ期低位直肠癌局部切除术临床应用的合理性.方法 回顾性分析93例Ⅰ期(T1-2N0M0)低位直肠癌患者的资料.按手术方式不同分为:局部切除术组(45例)和根治术组(48例).局部切除术组均行经肛门局部切除术,术后T1期(24例)行辅助放疗,T2期(21例)行辅助放、化疗.根治术组(T1期18例,T2期30例)均行根治术(行腹会阴联合切除术42例,低位前切除术6例),术后未行放、化疗.所有患者均随访5年以上.对两组患者的生存率、复发率、并发症发生率进行比较分析.结果 (1)局部切除术组和根治术组5年生存率T1期均为100%(24/24,18/18),T2期分别为86%(18/21)和93%(28/30),两组比较差异无统计学意义(P＞0.05).(2)局部切除术组和根治术组5年复发率T1期分别为4%(1/24)和0(0/18),T2期分别为19%(4/21)和7%(2/30),两组比较差异无统计学意义(P＞0.05).(3)局部切除术组并发症发生率为2%(1/45),根治术组为15%(7/48),前者显著低于后者(P＜0.05).结论 对于Ⅰ期低位直肠癌,经肛门局部切除术联合术后放、化疗可获得与根治术相近的5年生存率,是一种合理的治疗方式.

Transanal local excision for stage Ⅰ low rectal carcinoma

Objective To assess the validity of transanal local excision for stage Ⅰ low rectal carcinoma.Methods The clinical data of 93 patients with stage Ⅰ low rectal carcinoma who underwent transanal excision (group A,n=45)or radical resection(group B,n=48)were retrospectively analyzed.Twenty-four T1 patients and 21 T2 patients in group A received postoperative adjuvant radiation therapy and adjuvant chemoradiotherapy,respectively.All patients in group B received radical surgery only.The 5-year survival rates,recurrence rates,and postoperative complications between the 2 groups were compared.Results The 5-year survival rates were 100%(24/24)for T1 patients,86%(18/21)for T2 patients in group A,and 100%(18/18)for T1 patients,93%(28/30)for T2 patients in group B,with no significantly statistical difference between the 2 groups(P＞0.05).The recurrence rates were 4%(1/24)for T1 patients,19%(4/21)for T2 patients in group A,and 0(0/18)for T1 patients,7%(2/30)for T2 patients in group B,with no significance between the 2 groups(P＞0.05).The incidence of postoperative complications in group A was 2%(1/45),which was significantly lower than that of 15%(7/48))in group B(P＜0.05).Conclusions Transanal local excision of early low rectal carcinoma,combined with postoperative chemotherapy for T1 patients or chemoradiotherapy for T2 patients, results in a low complication rate and good sphincter function,and provides satisfactory local control and 5-year survival rates.