低位直肠癌两种不同根治方式的疗效分析

Comparison of treatment efficacy of two different radical resections,sphincter preserving operation and abdominal-perineal resection for lower rectal carcinoma

目的比较保留肛门括约肌手术和Miles手术治疗低位直肠癌的临床疗效。方法 2000年1月至2010年3月503例低位直肠癌患者接受根治性手术,回顾性分析其临床病理及随访资料,比较不同手术方式患者的一般资料、术后并发症、复发转移率和5年生存率等。结果 307例患者接受保肛手术治疗,196例接受Miles手术。Miles手术组中分化差肿瘤以及Dukes分期较晚肿瘤的比例高于保肛手术组。术后总体局部复发率为4.2%(21/503),其中保肛手术组为4.9%(15/307),Miles手术组为3.1%(6/196),差异无统计学意义(P=0.318);术后总体远处转移率为9.9%(50/503),两组差异无统计学意义(P=0.448)。Miles手术组术后总体1、3、5年生存率分别为92.9%,69.0%,56.8%,保肛手术组为92.0%,76.4%,62.5%,两组间差异无统计学意义(P=0.278)。结论低位直肠癌保肛术后的复发转移率和5年生存率与Miles术基本相当,保留肛门括约肌手术应当成为低位直肠癌的首选术式。具体术式应根据病变位置、肿瘤生物学特性及临床分期进行个体化选择。

Objective To compare and analyze the clinicopathological parameters and treatment efficacy of two different radical resections,sphincter-preserving operation and abdominal-perineal resection for lower rectal carcinoma.Methods Clinicopathological data of 503 cases with lower rectal carcinoma who underwent radical Miles operation or sphincter preserving operations form Jun 2000 to Mar 2010 were compared.The treatment efficacy of the two different radical resections was analyzed.Results Among the all cases,307 received sphincter-preserving operations,while the other 196 cases received Miles operation.The proportion of poorly-differentiated and late Dukes staged tumors were significantly higher in Miles operation group than those in sphincter-preserving operation group.The local recurrence rate was 3.1%(6/196)in Miles operation group and 4.9%(15/307) in sphincter-preserving operation group respectively(P=0.318).There were no significant differences in local recurrence and distant metastasis between the two groups.The overall 1,3 and 5-year survival rates were 92.9%,69.0% and 56.8% in Miles operation group,92.0%,76.4% and 62.5% in sphincter preserving operation group respectively(P=0.278).Conclusions The local recurrence and distant metastasis rates,and overall 5-year survival rate are comparable between Miles operation group and sphincter-preserving operation group.The operation for lower rectal cancer should be chosen individually according to tumor location,biological characteristics and clinical stage.