局部切除治疗下段直肠癌

LOCAL EXCISION OF DISTAL RECTAL CARCINOMA

１９８５年以来，作者对１４例下段直肠癌行局部切除。除１例外均根冶性切除。全部病变均在齿状线上方５ｃｍ以内。８例为溃疡型，６例为广基息肉型。１３例为高分化腺癌，１例为中分化腺癌。９例侵犯粘膜下层（Ｔ１），５例侵犯固有肌层（Ｔ２）。３例行粘膜下包括浅肌层切除，１１例为全层盘状切除。手术均经肛门入路。４例Ｔ２术后辅助放行４０～４５Ｇｙ。１１例随访２年以上，唯一１例２年内复发者为Ｔ２行姑息切除者。局部切除作为下段直肠癌的根治性手术仅适应于一小部分早期分化好的腺癌；对老年或全身情况不耐受大手术，或拒绝结肠造口者亦可作为姑息手术。如严格掌握局部切除的适应证，其疗效可与其他根治手术相等。

n the past eight years , 14 cases of distal rectal adenocarcinoma were treatedby local excision (LE). Thirteen were excised for cure and one for palliation.All lesions located within scm above the dentate line. Grossly there were 8 ul-cerative and 6 sessile type. Microscopically 13 were well differentiated adenocar-cinoma and one moderately differentiated. As for the depth of penetration . therewere 9 T1 and 5 T2. Three submucosal excision including inner muscularis propria and 11 whole thickness disc excision were done transanally. Four patientswith T, had postoperative radiation (40～45Gy). Eleven cases were followed upmore than two years. Only one patient had recurrence which occurred in pallia-tive excision for T2. For curative treatment LE is indicated in the subgroup ofpatients with early lesion of a favorable histologic grade. It also has a place forpalliation in patients of old age or poor general health to withstand a niajor oper-ation or unwilling to accept a colostoniy. The results of LE are comparable tothose of radical procedure when strict criteria of patient selection are followed.