两种术式治疗高龄早期低位直肠癌的疗效比较

Comparative study on clinical efficacy of two different surgical methods for early low rectal carcinoma in elderly and weak patients

目的评估选择性痔上黏膜切除术(tissue selecting therapy,TST)治疗高龄pT1低位直肠癌的临床疗效。方法选择大连市友谊医院普通外科自2011年1月至2015年12月收治的高龄早期低位直肠癌(cT1N0M0)患者60例,按入院顺序奇偶法随机分成研究组和对照组,每组各30例,研究组选用TST局部切除病灶,对照组选用经肛门内镜显微手术(transanal endoscopic microsurgery,TEM)局部切除病灶,两组均遵循早期肿瘤学手术原则,比较两组患者的术中情况和术后情况。结果两组均成功完成手术。研究组手术平均时间明显低于对照组(P<0.05),而两组术中出血量差异无统计学意义(P>0.05)。1例对照组患者术后病理为pT2并手术切缘阳性而行补救手术;研究组术后早期疼痛评分明显低于对照组(P<0.05),两组术后大出血、术后住院总时间、肿瘤切缘完整性、临床疗效及住院总费用差异无统计学意义(P>0.05);研究组和对照组随访期间无一例出现复发或远处转移,且两组随访的生存曲线无明显变化(P>0.05)。结论在高龄的pT1低位直肠癌治疗中,TST术式疗效与TEM术式相当;TST术式操作方法简便,肿瘤学行为安全、可行,临床疗效显著,值得临床推广应用。

Objective To evaluate clinical efficacy of tissue selecting therapy(TST) for pT1 low rectal carcinoma in elderly and weak patients. Methods Sixty elderly and weak patients with early low rectal carcinoma(cT1 N0 M0), who were admitted to the Department of General Surgery in Dalian Municipal Friendship Hospital from January 2011 to December 2015, were selected. The patients were randomly divided into a study group(n=30) who underwent TST and a control group(n=30) who underwent transanal endoscopic microsurgery(TEM). Both groups of patients were treated following the principles of early tumor surgery. The intraoperative and postoperative conditions were compared between the two groups. Results Surgeries were successfully completed in both groups of patient although the average operation time in study group was significantly lower than that in control group(P<0.05). The intraoperative blood loss was similar between two groups(P>0.05). Only one patient underwent remedial operation in control group because of postoperative pathologic staging of pT2 and a positive surgical margin. There were no significant differences between two groups in postoperative hemorrhage, total length of stay after surgery, integrity of surgical margin, clinical effect and all-in cost(P>0.05), however, the postoperative early pain score in study group was prominently lower than that in control group(P<0.05). No recurrence or distant metastasis occurred during the follow-up and follow-up survival curve demonstrated no significant difference between two groups(P>0.05). Conclusion In the treatment of elderly and weak patients with pT1 low rectal carcinoma, TST is similar to TEM. TST is worthy of clinical popularization and application due to its easy operative procedure, safe and feasible oncological behavior, and conspicuous clinical effect.