经肛门局部切除术治疗早期低位直肠癌的疗效分析

Efficacy of transanal local resection for early low rectal cancer

目的探讨经肛门局部切除术治疗早期低位直肠癌的临床疗效。方法回顾性分析1997年1月至2009年4月福建医科大学附属协和医院收治的72例早期低位直肠癌患者的临床资料，其中经肛门局部切除术31例（局切组），传统经腹根治术41例（根治组）。两组术后局部复发率、远处转移率采用X^2检验和Fisher确切概率法；生存率采用寿命表法，生存率的比较采用Wileoxon检验。结果局切组术后未发生并发症，根治组3例出现并发症。局部复发率：局切组为6％（2／31），根治组为0（0／41），两组比较差异有统计学意义（P〈0．05）。远处转移率：局切组为6％（2／31），根治组为2％（1／41），两组比较差异无统计学意义（X^2=0．062，P〉0．05）。局切组的3、5年生存率分别为93％和87％，而根治组分别为95％和91％，两组比较差异无统计学意义（X^2=0．099，0．144，P〉0．05）。结论早期低位直肠癌选择经肛门局部切除术可以达到与传统经腹根治术一样的预后。在严格掌握其手术适应证的前提下，经肛门局部切除术治疗早期低位直肠癌是安全可行的。

Objective To evaluate the efficacy of transanal local resection for early low rectal cancer. Methods The clinical data of 72 patients with early low rectal cancer who had been admitted to Union Hospital of Fujian Medical University from January 1997 to April 2009 were retrospectively analyzed. Patients were divided into 2 groups, and they received transanal local resection （group A, n =31） and radical resection （group B, n = 41）, respectively. Postoperative local recurrence and distal metastasis were analyzed by Fisher exact test, the survival was analyzed by life table method. The difference in survival between the 2 groups was analyzed by Wilcoxon test. Results Three patients were found to have surgical complications in group B, while no complication was detected in group A. The local recurrence was 6% （ 2/31 ） in group A and 0 （0/41 ） in group B （ P 〈 0.05 ） ; the distal metastasis was 6% （2/31） in group A and 2% （ 1/41 ） in group B, with no significance difference between the 2 groups （X^2 = 0. 062, P 〉 0.05 ）. The 3- and 5-year survival rates were 93% , 87% in group A, and 95%, 91% in group B, with no significant difference between the 2 groups （X^2 =0. 099, 0. 144, P 〉0.05）. Conclusions The prognosis of patients with early low rectal cancer who received transaual local resection is similar to those who received radical resection. Transanal local resection is safe and feasible when the indications are strictly followed.