31例直径1~2 cm直肠类癌的手术治疗

  目的  探讨直径1~2 cm直肠类癌的临床特点及手术方式选择。  方法  回顾性分析北京协和医院2000年1月至2012年12月收治的31例直径在1~2 cm之间的直肠类癌患者的临床资料。其中男17例, 女14例; 年龄24~77岁, 中位年龄46岁。  结果  31例患者中, 临床表现为腹部不适、排便次数增多18例(58.1%), 便血2例(6.5%); 余11例患者无症状。本组患者行局部切除术26例, 包括经肛门内镜微创手术19例(61.3%), 经肛门括约肌途径直肠肿物切除术(Mason术)4例(12.9%), 经肛门肿物切除术3例(9.7%); 行根治性切除手术5例(16.1%)。术后病理回报所有病例均为直肠类癌, 病变局限于黏膜下层25例; 浸润肌层6例, 其中淋巴结转移1例。29例患者得到随访, 病变局限于黏膜下层者(n=23)5年生存率为95.7%, 浸润肌层者(n=6)5年生存率为50%(P < 0.001)。  结论  直径1~2 cm直肠类癌, 病变局限于黏膜下层者可行局部切除, 病变侵及肌层者行根治性切除为妥。

Surgery for Rectal Carcinoids of 1 -2 cm in Diameter in 31 Patients

Objective To investigate the clinical features of and surgical choices for rectal carcinoids of 1 -2 cm in diameter. Methods The clinical data of 31 rectal carcinoid patients with tumors of I -2 cm in diameter who were treated in Peking Union Medical College Hospital between January 2000 and December 2012 were col- lected and analyzed retrospectively. The selected patients included 17 males and 14 females, aged 24 -77 years （median age 46 years）. Results Abdominal discomfort and diarrhea （ 18/31, 58. 1% ） were the most common symptoms. Two （2/31, 6. 5% ） patients had hematochezia. The other 11 were asymptomatic. Twenty-six patients underwent local excision： transanal endoscopic microsurgery （TEM） in 19 （61.3%）, transsphineteric resection （York-Mason approach） in 4 （12. 9% ）, and transanal excision in 3 （9. 7% ）. Five （16. 1% ） patients received radical surgery . Postoperative pathological results showed rectal carcinoid in all the 31 patients, including limited submucosal lesions in 25 cases and muscular invasion in 6. Lymph node metastasis occurred in 1 case. Among the 29 patients who were followed up, the 23 patients with limited submueosal lesions had a 5-year survival rate of 95.7%, significantly higher than that of the 6 patients with muscular invasion （50%, P 〈0. 001 ）. Conclusion For the rectal carcinoid tumors of 1 -2 cm in diameter without muscular invasion, local excision is an appropriate surgical choice; while for those with muscular invasion, radical resection is necessary.