经肛局部切除术治疗低位直肠癌(附26例报告)

Transanal local excision of lower rectal carcinoma:Report of 26 cases

目的 :总结经肛门局部切除术治疗低位直肠癌的经验。方法 :回顾性分析 1 991～ 2 0 0 0年收治的 2 6例经肛门局部切除治疗者的临床资料。结果 :(1 ) 2 6例均为直肠腺癌 ;(2 ) 2 6例直肠癌 T0 1 0例 ,T1 期 9例 ,T2 期 7例。(3)围手术期病死率为 0。(4 )术后特异性并发症仅有 1例 ,占 38.5 %。 (5 )有 4例局部复发。其中 1例经局部切除治愈。另外 3例经腹会阴联合切除术 ;(6 )本组直肠癌病人经肛门局部切除术后 ,随访都超过 2年 ,5年生存为 83.4 %。结论 :经肛门局部切除治疗直肠癌适于 T1 ～T2 ,N0 M0 、组织分化好 ,距肛缘 6 cm以内的肿瘤 ,但严格掌握适应证 ,完整的肿瘤切除 ,术中预防肿瘤种植是预防复发的关键。术后应进行密切随防 。

Objective:To evaluate the results of transanal local excision for lower rectal carcinoma Methods:Clinical materinls of 26 patients with lower rectal carcinoma admitted to our hospital from 1991 to 2000 were analysed retrospectively.All tumors were resected transanally Results:(1)In this group,all 26 tumors were adenocarcinoma.(2)According to tge stage,10 cases were T 0,9 were T 1 and 7 were T 2 among 26 cases of rectal carcinoma.(3)There was no perioperative mortality in this group.(4)There was only 1 cases of postoperative specific complication (38 5%).(5)There were 4 cases of local recurrence.Of them,one patients was salvaged by local excision.The other 3 patients were treated by abdominoperineal resection.(6)In this group,the tollow up time of every patient was more than two years,and the five year survival ration was 83 4% Conclusion:Local excision for rectal carcinoma might only be successtully perfomed in selected patients (T 1~T 2,N 0M 0,well or moderately differentiated carcinoma,low RvC within 6 cm trom anal edge).The indications of transanal local excision must be controlled stristly.Total excision of tumor and prevention of implantation of carcinoma are the main points in the prophylaxes of recurrence.Postoperative follow up is needed in order to find local recurrence as early as possible