低位直肠癌经肛门局部切除40例疗效分析

目的 探讨低位直肠癌经肛门局部切除的适应证和疗效.方法 回顾性分析1997年1月至2006年12月间广东省人民医院普通外科40例低位直肠癌患者经肛门局部切除的临床资料.结果 本组患者平均手术时间50（30～85）min,术中出血量40（10～100）ml,平均住院时间5（2～10）d.全组患者平均随访时间40（6～120）个月.术后局部复发率为20.0%（8/40）,5年生存率为90.0%.T1期患者术后局部复发率为17.9%（5/28）,低于T2期患者的25.0%（3/12）,但两组差异无统计学意义（x2=0.268,P=0.61） 高分化腺癌患者术后局部复发率为12.9%（4/31）,明显低于中分化腺癌的4/9,两组差异有统计学意义（x2=4.337,P=0.04） 肿瘤直径小于3 cm者术后局部复发率为10.7%（3/28）,明显低于大于或等于3 cm者的41.7%（5/12）,两组差异有统计学意义（x2=5.030,P=0.03）.经肛门局部切除术后局部复发率与肿瘤部位（x2=0.139,P=0.93）、分型（x2=1.290,P=0.53）和手术切除方式（x2=0.667,P=0.41）无关.结论 低位直肠癌经肛门局部切除适应证为肿瘤直径小于3 cm和高分化的T1、T2期患者.只要严格掌握手术适应证,经肛门局部切除治疗低位直肠癌可获取良好的疗效.

Efficacy analysis of transanal local excision in low rectal cancer:report of 40 cases

Objective To explore the indication and efficacy of transanal local excision for low rectal cancer.Methods A total of 40 consecutive patients undergoing transanal local excision of low rectal cancer were analyzed retrospectively.Results The mean operative time was 50 (30-85)minutes.The mean intraoperative blood loss was 40 (10-100)ml.The mean hospital stay was 5(2-10) days.The local recurrence rate was 20.0% (8/40).The 5-year survival rate was 90.0%.Local recurrence rate was 17.9% (5/28 cases) for T1,and 25.0% (3/12) for T2 lesions.However,the difference between the two groups was not statistically significant (P=0.61).Local recurrence rate was significantly lower for moderate differentiated than that for well-differentiated cancer 12.9% (4/31) vs.44.4% (4/9),P=0.037].Tumor diameter less than 3 cm was associated with a significantly lower local recurrence rate as compared to the counterparts (10.7% vs.41.7% ,P=0.03).No significant correlations were found between local recurrence and other variables inlcuding tumor location (P=0.93),tumor classification (P=0.53),and method of surgical excision (P=0.41).Conclusions Indications for transanal local excision of low rectal cancer include T1 and T2 tumors with well differentiation and the diameter less than 3 cm.Clinical outcome may be favorable if patients are carefully selected for transanal local excision.