直肠癌经肛门内镜微创手术(TEM)治疗后的疗效评价

Curative effect analysis of transanal endoscopic microsurgery operation(TEM) in rectal carcinoma

目的探讨经肛门内镜微创手术(TEM)对直肠癌的疗效情况及TEM适应证。方法对2006年9月至2012年9月在本院行手术治疗的86例临床患者进行回顾性分析。结果本组直肠癌pTis 26例、pT1期42例、pT2期18例。全部病变均达到全层切除,未残留肿瘤组织,切除面阴性。无重大手术并发症及手术死亡病例。术后随访12~72个月(平均37.6个月)。失访9例(10.47%),肿瘤原发部位复发9例(10.47%),其中pTis复发1例(3.85%),pT1期复发2例(4.76%),pT2期复发6例(33.3%);死亡3例(3.48%)。死亡3例均出现在T2期肿瘤内。pT2期肿瘤复发比例显著高于pT1期肿瘤患者(χ2=9.806,P<0.05)。52例肿瘤直径<3cm患者中复2例(3.85%),34例肿瘤直径>3cm患者中复发7例(20.59%),显著高于肿瘤直径<3cm患者(χ2=4.493,P<0.05)。结论 TEM针对pTis及pT1期,直径<3cm的早期直肠癌患者有较好的疗效,值得推广。

Objective To study transanal endoscopic microsurgery operation （TEM） effect of rectal carcinoma, and to explore the TEM operation indications. Methods Eighty-six patients with rec tal carcinoma undergoing TEM between September 2006 and September 2012 in the Qianfoshan Hospital of Shandong were included in this study and the data was retrospectively analyzed. Re- suits There were 26 cases patients with pTis rectal carcinoma, 42 cases with pT1 and 18 cases with pT2. All lesions were full-thickness resection, no positive resection margins was reported, no major surgery com （mean 37.6 months）, plications and deaths. The patients were followed up for 12-72 months 9 cases（10.47%） were lost to follow-up. The original site of the tumor was recurred in 9 cases（10.47%）, 1 case（3.85%） of Tis stage recurrence, 2 cases（4.76%） of T1 stage recurrence, 6 cases（33.3%） of T2 stage recurrence, 3 cases（3.48%） died. The death of 3 cases were in stage T2 rectal cancer. T2 stage tumor recurrence rate was patients with stage T1 tumors （Z2=9.806, P^0.05）. 2 cases（3.85 significantly %） recurred higher in 52 cases patients with tumor diameter 〉3cm, 7 cases（20.59%） recurred in 34 cases patients with tumordiameter〉3cm, which was sign 4. 493, P〈0.05）. Conclusion ificantly higher than patients with tumor %3cm in diameter（x2= TEM for pTis and pT1 tumor, diameter〈3cm rectal malignant tumor patients has good curative effect, is worth promoting