低位直肠癌局部切除术的合理选用

1988·1-1994·12手术治疗结直肠癌886例中，癌肿局限肠壁内者324例，按照国际TNM分期，属Tis17例，T2 264例，Tis组中全部为No，T1组中有3例N1，占6.98%，无M1-T2组中N1 74例，占28.03%，M1 10例，占3.79%，不同大体类型癌肿的Tis和T1并无明显区别，增生型T1的N1占27.12%，溃疡型T1的N1占28.95%，浸润型T2的N1占28.13%，三者亦无差异（P>0.05），不同恶性程度Tis与T1间并无区别，低恶性T2的N1占21.43%，一般恶性的N1占27.93%，二者相比P>0.05，高恶性T3的N1占42.86%，与前二者相比，差异显著（P<0.05），324例中有35例低位直肠癌采用局部切除术治疗，占同期低位直肠癌的9.38%，无手术死亡，除1例T1于术后2年出现局部复发，再次行Miles术后又2年死亡外，余均健在，21例术后存活已大农业3年心上，10例存活已满5年，表明肌层浸润不但具有较高淋巴播散率，且有远处转移可能，为保证手术手术疗效，局部切除术应仅限于病变局限在粘膜或粘膜下，≤3cm，低恶性或一般恶性的癌肿。

RATIONAL SELECTION OF LOCAL EXCISION IN LOW RECTAL CANCER

From Jan. 1988 to Dec. 1994 324 cases with colorectal cancer confining to the bowel wall treated by surgical excision were analyzed. Classifying the patients according to the in-ternational TNM system showed. Tis group 17 cases, T1 group 43 cases and T2 group 264 cases. In the Tis group all cases did not show any lymph node involvement, that is, No; in the T1 group 3 cases showed N1 involvement (6. 98%), but without distant metastasis (M1) ; in the T2 group 74 cases (28. 03%) showed N1 involvement, and 10 cases had distant metastasis (M1). There were no significant differences between the various macroscopic tumor types of Tis and T1 groups. The highly malignant T2 cases had a higher lymph node involvement (42.86%) than the low or average mlignant T2 cases (P<0.05). Of the above 324 cases, 35 cases were treated by local surgical excision, with no death due to surgical operation. Except in one case, all cases were still alive, in which 21 cases survived for more than 3 cases, and 10 cases survived more than 5 years. The results suggest that cases with muscular tumor cell infiltration not only have higher lymph node involvement rate, but also have greater chances of distant metastasis. Hence, local surgical excision should be used only in those cases in which the tumors are confined in the mu-cosa or submucosa, with mass less than 3cm, and of low or on the average malignancy.