影响低位直肠癌局部切除选择的因素分析

Factors affecting the prognosis and selection of local excision for low rectal cancer

目的探讨低位直肠癌局部切除选择的影响因素。方法回顾性分析101例局部切除治疗低位直肠癌患者的临床资料。Kaplan—Meier法计算生存率，并对预后进行单因素及多因素分析。结果经肛门切除91例，经骶骨切除9例，经阴道切除1例，并发症发生率为5．9％，全组无手术死亡病例。术前放疗5例，术后放疗34例。5年生存率为91．0％，Tis、T1、T2及乃或T4病变的5年生存率分别为100％、92．6％、77．1％和83．3％；局部复发率为15．8％。单因素分析显示，肿瘤的侵袭深度、直径＞3cm、有脉管瘤栓、溃疡型癌、放射治疗和局部复发与预后有关（P＜0．05）。多因素分析显示，肿瘤直径＞3cm、局部复发是影响预后最重要的因素（P＜0．05）。结论低位直肠癌病理为高中分化、直径≤3cm、无脉管瘤栓的T1病变及原位癌，是局部切除术的合理适应证。

Objective To investigate the factors affecting the result and selection of local excision for low rectal cancer. Methods The chnical data of 101 patients with low rectal cancer treated by local excision were retrospectively analyzed. Survival was estimated using the Kaplan-Meier. The factors influencing on the survival were analyzed using univariate （ Log rank） and multivariate （ Cox model） analysis methods. Results Of 101 patients in this series, 91 patients underwent transanal excision, 9 had transsacral excision, 1 recieved transvaginal excision. Postopertative complication developed in 6 patients （5.9%）. No death occurred within 30 postoperative days. Five T4 patients underwent preoperative radiotherapy, and 34 received postoperative radiotherapy. The overall 5-year survival rate was 91.0% for the whole group, and it was 100%, 92. 6%, 77.1%, 83.3% for patients with Tis, T1, T2, and T3/T4 lesion, respectively. The incidence of local recurrence was 15. 8%. Univariate analysis revealed that pathological T stage, tumor size （ 〉 3 cm）, lymphovascnlar invasion, ulcerative lesion, adjuvant radiotherapy and local recurrence were significant factors affecting the survival （ P 〈 0. 05 ）. However, by multivariate analysis, only tumor size （ 〉 3 cm） and local recurrence were found to be the significant prognostic predictors. Conclusion The important selection criteria for local excision in the treatment of low rectal cancer may include T1 stage, well or moderate differentiation, tumor size≤3 cm, no lymphovascular invasion.