目的研究单吻合器法经肛门取出标本在超低位直肠癌保肛手术的临床疗效。方法回顾性分析2016年1月—2018年1月同济大学附属东方医院胃肠肛肠外科行腹腔镜直肠前切除术的112例超低位直肠癌患者临床资料。其中单吻合器法经肛门取标本手术83...目的研究单吻合器法经肛门取出标本在超低位直肠癌保肛手术的临床疗效。方法回顾性分析2016年1月—2018年1月同济大学附属东方医院胃肠肛肠外科行腹腔镜直肠前切除术的112例超低位直肠癌患者临床资料。其中单吻合器法经肛门取标本手术83例,双吻合器法小切口手术29例,对比两组患者在手术时间、出血量、住院时间、初次造口排便时间、淋巴结检出数、下切缘长度、术后吻合口瘘发生率、肛门Wexner失禁评分以及1年无病生存率(disease-free survival, DFS)等方面的差异。结果全部112例手术顺利完成,两组患者在手术时间、出血量、淋巴结检出数、肛门Wexner失禁评分及1年DFS等方面差异无统计学意义( P >0.05);单吻合器组住院天数少于双吻合器组,分别为(7.9±3.5) d和(10.2±2.5) d,差异有统计学意义( P <0.01);两组初次造口排气时间分别为(13.7±6.0) h和(44.6±5.2) h,差异有统计学意义( P <0.01);两组肿瘤下切缘长度分别为(1.8±0.3) cm和(1.6±0.2) cm,差异有统计学意义( P <0.01);吻合口瘘发生率分别为2/83和4/29,差异有统计学意义( P <0.01)。结论与传统双吻合器法相比,单吻合器法经肛门取出标本进行超低位直肠癌保肛安全可行,可缩短住院时间、促进术后恢复。展开更多
Background Neoadjuvant chemoradiation is now considered the standard care for locally advanced rectal carcinoma （T3-4 or/and N1-2 lesions）, but the accuracy of staging examinations including endorectal ultrasonograp...Background Neoadjuvant chemoradiation is now considered the standard care for locally advanced rectal carcinoma （T3-4 or/and N1-2 lesions）, but the accuracy of staging examinations including endorectal ultrasonography （ERUS） and MRI is far from excellent. In addition, the above staging equipment or professionals who perform the examinations may not be available in some hospitals, while preoperative colonoscopy and biopsy are usually obtainable in most hospitals.The objective of the present study was to investigate the clinical and pathological characteristics of locally advanced rectal carcinoma and identify candidates for neoadjuvant chemoradiation.Methods This was a retrospective study. Patients who were treated for rectal cancer at Changhai Hospital from January 1999 to July 2008 were identified from our prospectively collected database. Statistical analysis was performed using SPSS Software System （version 15.0）. The Mann-Whitney test, chi-square test and multivariate Logistic regression analysis were performed,Results A total of 1005 cases were included in this research, of which 761 cases were identified as locally advanced rectal carcinoma depending on postoperative TNM staging. The results of multivariate Logistic regression analysis indicated seven independent risk factors that could be used to predict a locally advanced rectal carcinoma independently： a high grade （including poor differentiation and undifferentiation） （OR： 3.856; 95% CI： 2.064 to 7.204;P=0.000）; large tumor size （OR： 2.455; 95% CI： 1.755 to 3.436; P=0.000）; elevated preoperative serum CEA level （OR：1.823; 95% CI： 1.309 to 2.537; P=0.000）; non-polypoid tumor type （OR： 1.758; 95% CI： 1.273 to 2.427; P=0.001）; the absence of synchronous polyps （OR： 1.602; 95% CI： 1.103 to 2.327; P=0.013）; the absence of blood in stool （OR： 1.659;95% CI： 1.049 to 2.624; P=0.030）; and a greater circumferential tumor extent （OR： 1.813; 95% CI： 1.055 to 3,113;P=0.031）. Based on these findings, a Logistic equation was established, the accuracy of which was 64% according to the information of the additional 50 cases.Conclusions Some independent risk factors related with locally advanced rectal carcinoma were identified, based on which it is possible to establish a Logistic equation as a tool to predict candidates of neoadjuvant chemoradiation.Further research about optimization of the equation is warranted.展开更多
文摘目的研究单吻合器法经肛门取出标本在超低位直肠癌保肛手术的临床疗效。方法回顾性分析2016年1月—2018年1月同济大学附属东方医院胃肠肛肠外科行腹腔镜直肠前切除术的112例超低位直肠癌患者临床资料。其中单吻合器法经肛门取标本手术83例,双吻合器法小切口手术29例,对比两组患者在手术时间、出血量、住院时间、初次造口排便时间、淋巴结检出数、下切缘长度、术后吻合口瘘发生率、肛门Wexner失禁评分以及1年无病生存率(disease-free survival, DFS)等方面的差异。结果全部112例手术顺利完成,两组患者在手术时间、出血量、淋巴结检出数、肛门Wexner失禁评分及1年DFS等方面差异无统计学意义( P >0.05);单吻合器组住院天数少于双吻合器组,分别为(7.9±3.5) d和(10.2±2.5) d,差异有统计学意义( P <0.01);两组初次造口排气时间分别为(13.7±6.0) h和(44.6±5.2) h,差异有统计学意义( P <0.01);两组肿瘤下切缘长度分别为(1.8±0.3) cm和(1.6±0.2) cm,差异有统计学意义( P <0.01);吻合口瘘发生率分别为2/83和4/29,差异有统计学意义( P <0.01)。结论与传统双吻合器法相比,单吻合器法经肛门取出标本进行超低位直肠癌保肛安全可行,可缩短住院时间、促进术后恢复。
文摘Background Neoadjuvant chemoradiation is now considered the standard care for locally advanced rectal carcinoma （T3-4 or/and N1-2 lesions）, but the accuracy of staging examinations including endorectal ultrasonography （ERUS） and MRI is far from excellent. In addition, the above staging equipment or professionals who perform the examinations may not be available in some hospitals, while preoperative colonoscopy and biopsy are usually obtainable in most hospitals.The objective of the present study was to investigate the clinical and pathological characteristics of locally advanced rectal carcinoma and identify candidates for neoadjuvant chemoradiation.Methods This was a retrospective study. Patients who were treated for rectal cancer at Changhai Hospital from January 1999 to July 2008 were identified from our prospectively collected database. Statistical analysis was performed using SPSS Software System （version 15.0）. The Mann-Whitney test, chi-square test and multivariate Logistic regression analysis were performed,Results A total of 1005 cases were included in this research, of which 761 cases were identified as locally advanced rectal carcinoma depending on postoperative TNM staging. The results of multivariate Logistic regression analysis indicated seven independent risk factors that could be used to predict a locally advanced rectal carcinoma independently： a high grade （including poor differentiation and undifferentiation） （OR： 3.856; 95% CI： 2.064 to 7.204;P=0.000）; large tumor size （OR： 2.455; 95% CI： 1.755 to 3.436; P=0.000）; elevated preoperative serum CEA level （OR：1.823; 95% CI： 1.309 to 2.537; P=0.000）; non-polypoid tumor type （OR： 1.758; 95% CI： 1.273 to 2.427; P=0.001）; the absence of synchronous polyps （OR： 1.602; 95% CI： 1.103 to 2.327; P=0.013）; the absence of blood in stool （OR： 1.659;95% CI： 1.049 to 2.624; P=0.030）; and a greater circumferential tumor extent （OR： 1.813; 95% CI： 1.055 to 3,113;P=0.031）. Based on these findings, a Logistic equation was established, the accuracy of which was 64% according to the information of the additional 50 cases.Conclusions Some independent risk factors related with locally advanced rectal carcinoma were identified, based on which it is possible to establish a Logistic equation as a tool to predict candidates of neoadjuvant chemoradiation.Further research about optimization of the equation is warranted.
