低位直肠癌经肛门局部切除疗效观察

Efficacy of transanal local excision in the treatment of low rectal cancer

目的评价经肛门局部切除治疗低位直肠癌的效果。方法回顾性分析我院2003—2006年49例低位直肠癌经肛门行局部切除术患者（局部切除术组）的临床资料，其中T，期37例，T2期12例；以45例行根治术的I期直肠癌患者作为对照（根治术组），其中T1期11例，T2期34例。将两组患者的手术并发症发生率、5年复发率、5年生存率进行对比分析。结果局部切除术组并发症发生率为4．1％（2／49），根治术组为15．6％（7／45），两组比较差异有统计学意义（X2=4．69，P〈0．05）。局部切除术组患者5年生存率为97．9％，根治术组患者为95．6％，两组比较差异无统计学意义（x2=0．439，P〉0．05）。局部切除术组中T2期患者术后复发率为33．3％（4／12），高于根治术组T2期患者术后复发率（5．9％，2／34），两者比较差异有统计学意义（x2=5．89，P〈0．05）；低分化癌患者术后均转移复发。结论对于T1期直肠癌，经肛门局部切除是合理选择，而T2期直肠癌及低分化肿瘤不宜单纯采用局部切除术。

Objective To evaluate the therapeutic effect of transanal local excision in the treatment of low rectal cancer. Methods The data of 49 cases of low rectal cancer patients treated by transanal local excision （group A,37 cases of T1 patients and 12 cases of T2 patients） were reviewed retrospectively, and compared with the group of 45 cases treated by radical resection（ group B, 11 cases of T1 patients and 34 cases of T2 patients）. The 5-year survival rates, recurrence rates and postoperative complications between the two groups were compared. Results The incidence of postoperative complications in group A was significandy lower than that in group B（4. 1% vs 15.6% ,X2 =4. 69 ,P 〈0. 05 ）. The 5-year survival rate of group A was 97. 9% and the 5- year survival rate of group B was 95.6%. There was no significantly statistical difference on the 5-year survival rate between the two groups（ X2 = 0. 439 , P 〉 0. 05 ）. But for the T2 patients, the recurrence rates in group A was 33.3% ,which was significantly higher than the T2 patients in group B（5.9% ） （X2 =5.89,P 〈0. 05 ）. All patients with low histopathological grade tumor in group A showed postoperative recurrence and metastasis. Conclusion Transanal local excision with a rigid criteria can get good curative effect in the T1 patients, but not suitable for the T2 patients or patients with low histopathological grade tumor.