低位Ⅰ期直肠癌患者的外科治疗与预后分析

目的探讨低位Ⅰ期直肠癌的外科治疗效果及影响复发和预后的因素。方法回顾性分析166例低位Ⅰ期直肠癌患者的临床资料。结果本组根治性手术138例，均按直肠全系膜切除（TME）手术原则进行；其中93例行腹会阴联合根治术，45例行保肛手术；肿瘤局部切除术28例。局部复发率根治性手术者为5．1％（7／138），其中腹会阴联合根治术组为6．5％（6／93），保肛术组为2．2％（1／45）；局部切除术组为17．9％（5／28）。X^2检验显示，肿瘤分化程度（P=0．009）和手术方式（P=0．039）与局部复发相关。腹会阴联合根治术组5年生存率为90．4％，保肛术组为95．5％。局部切除术组为82．6％。单因素分析显示，肿瘤分化程度（P=0．000）和局部复发（P=0．000）与预后相关；多因素分析显示，局部复发是影响预后的主要因素（P=0．000）。结论低位Ⅰ期直肠癌根治性手术切除复发率低、预后好。局部切除术的选择应严格把握指征。

Analysis of recurrence and prognosis after surgical resection for I stage lower rectal carcinoma

OBJECTIVE: To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for I stage lower rectal carcinoma. METHODS: The related clinicopathologic factors for recurrence and prognosis of 166 patients with I stage lower rectal carcinoma after surgical resection were retrospectively analyzed using univariate and multivariate methods. RESULTS: A total of 138 patients with I stage lower rectal carcinoma received radical resection according to the operative rules of total mesorectal excision (TME). Ninety-three patients received abdominoperineal resection (APR) operation, 45 patients received sphincter preserving operation, and 28 patients received local excision. The local recurrence rates were 6.5% (6/93), 2.2% (1/45), 17.9% (5/28), respectively . Histological differentiation and operative procedures were associated with local recurrence. The 5-year survival rates were 91.1% in APR group, 95.5% in sphincter preservation group and 82.6% in local resection group. Univariate analysis revealed that histological differentiation and local recurrence were correlated with prognosis. Multivariate analysis revealed that local recurrence was the most important prognostic factor for I stage lower rectal carcinoma. CONCLUSIONS: Radical resection of I stage lower rectal carcinoma has low recurrence rate and better prognosis. Sphincter preserving operation and local excision must be strictly selected in proper patients.