直肠类癌局切后补充手术71例临床分析

Secondary surgery after primary local resection in rectal carcinoid:A clinical analysis of 71 cases

目的通过对直肠类癌病例的诊治分析,探索较为合适的处理方式。方法回顾性分析1985～2010年复旦大学附属医院收治的71例局部切除后行补充手术的直肠类癌的临床病理资料,并进行随访,中位随访64个月(1～352月)。Logistic回归分析肿瘤直径与肌层浸润及淋巴结转移的关系。结果肿瘤的直径与有无肌层浸润相关(P<0.001),肿瘤直径与有无淋巴结转移相关(P<0.001),肿瘤直径≤1 cm时,发生肌层浸润的机率为3.6%,淋巴结转移的机率为5.4%;肿瘤直径>2 cm时,发生肌层浸润的机率为75%,淋巴结转移的机率为50%。结论对于局部切除后的直肠类癌,如存在肌层浸润、直径大于2 cm和局部淋巴结转移等情况,建议应行补充根治术;如仅为局部残留,则行补充局部切除术。

Objective To explore the secondary surgery after primary local resection in the treatment of rectal earcinoid. Methods 71 rectal carcinoid patients undergoing secondary surgery for primary improper local resection were retrospectively collected from the Cancer Hospital Fudan University between 1985 and 2010. Median follow-up time was 64 montils [ 1 -352 months）. Logistic regression was used to analyze the relation between tumor diameter and muscular invasion and lymph node metastasis. Results Diameter of carcinoid correlated with muscular invasion and lymph node metastasis （P 〈 0. 001 ）. For carcinoid with diameterl≤cm, the rate of muscular invasion was 3.6%, and the rate of lymph node metastasis 5.4% ; for carcinoid with diameter 〉 2cm, the rate of nmscular invasion was 75% , and the rate of lymph node metastasis 50%. Conclusion For a patient of rectal carcionid who received local resection, if there are some risk factors such as muscular invasion, diameter 〉 2cm arid lymph node metastasis, a secondary radical surgery is recommended. If there are only residual lesions, a seconda- ry local resection will be proper.