摘要
内镜治疗直肠癌具有创伤小、并发症发生率低等优势,已成为早期直肠癌治疗的重要方式之一。然而,由于术前影像学评估存在局限性,且内镜切除无法清扫淋巴结,使得内镜治疗相较于传统根治术的局部复发率更高。因此,正确把握内镜治疗的适应证十分重要。对于内镜切除后病理学检查证实肿瘤残留、高复发风险pT1期直肠癌或pT2期以上进展期直肠癌,及时行补救性治疗可以有效降低复发率与转移发生率,改善病人预后。补救性根治术可清扫区域淋巴结,完整切除直肠系膜,根治效果佳,但手术时机争议较大,早期手术的术中穿孔风险高,易造成肿瘤播散;补救性放化疗对于高复发风险pT1期病人的治疗效果与补救性根治术相当且创伤小,但有关研究相对较少,而放化疗的敏感度评价也较困难。补救性根治术已推行多年,治疗效果确切,仍应视为补救性治疗的"金标准",但应把握适宜的手术时机、全面评估术中穿孔风险。对于保肛意愿强烈、拒绝根治手术或者不可耐受根治手术的病人,在充分告知复发风险后可选择补救性放化疗,但术后应密切随访。
Endoscopic treatment of rectal cancer has become one of the most important methods for the treatment of earlystage rectal cancer because of its micro-invasive features and low incidence of complications.However,due to the limitations of preoperative imaging examination and the inability to remove lymph nodes,the local recurrence rate is often higher than that of traditional radical surgery,so it is very important to correctly grasp the indications.For patients with high risk of recurrence and local recurrence during follow-up,timely remedial treatment can effectively reduce the recurrence rate and metastasis rate and improve the prognosis of patients.Remedial radical surgery can be used to resect regional lymph nodes and completely excise the mesentery with good radical effect.However,the timing of the operation is controversial,leading to a high risk of perforation in operation,which is prone to cause tumor residue and local recurrence.The therapeutic effect of remedial chemoradiotherapy on pT1 patients with high risk of recurrence is similar to that of remedial radical surgery with little trauma,but relevant studies are still relatively scarce and the sensitivity evaluation of chemoradiotherapy is difficult.Remedial radical surgery has been carried out for many years,and its definite therapeutic effect should still be regarded as the‘gold standard’among remedial treatment,but appropriate surgical timing should be grasped to comprehensively evaluate the risk of perforation in operation.Patients with strong desire to preserve the anus or reject surgery and patients who cannot tolerate radical surgery can choose remedial chemoradiotherapy as an important choice for remedial treatment after being fully informed of the risk of recurrence.These patients are supposed to be in close following-up procedure after the operation.
作者
李昀昊
白雪杉
林国乐
LI Yun-hao;BAI Xue-shan;LIN Guo-le(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2020年第3期322-325,共4页
Chinese Journal of Practical Surgery
基金
北京市科技重大专项基金(No.D171100002617003)
关键词
直肠肿瘤
内镜治疗
补救治疗
经肛门内镜显微手术
rectal cancer
endoscopic therapy
salvage treatment
transanal endoscopic microsurgery
