摘要
目的探讨低位Ⅰ期直肠癌的外科治疗效果及影响复发和预后的因素。方法回顾性分析166例低位Ⅰ期直肠癌患者的临床资料。结果本组根治性手术138例,均按直肠全系膜切除(TME)手术原则进行;其中93例行腹会阴联合根治术,45例行保肛手术;肿瘤局部切除术28例。局部复发率根治性手术者为5.1%(7/138),其中腹会阴联合根治术组为6.5%(6/93),保肛术组为2.2%(1/45);局部切除术组为17.9%(5/28)。χ2检验显示,肿瘤分化程度(P=0.009)和手术方式(P=0.039)与局部复发相关。腹会阴联合根治术组5年生存率为90.4%,保肛术组为95.5%,局部切除术组为82.6%。单因素分析显示,肿瘤分化程度(P=0.000)和局部复发(P=0.000)与预后相关;多因素分析显示,局部复发是影响预后的主要因素(P=0.000)。结论低位Ⅰ期直肠癌根治性手术切除复发率低、预后好。局部切除术的选择应严格把握指征。
Objective To investigate the clinicopathologic factors related with recurrence and prognosis after surgical resection for Ⅰ stage lower rectal carcinoma. Methods The related clinicopathologic factors for recurrence and prognosis of 166 patients with Ⅰ stage lower rectal carcinoma after surgical resection were retrospectively analyzed using univariate and multivariate methods. Results A total of 138 patients with Ⅰ stage lower rectal carcinoma received radical resection according to the operative rules of total mesorectal excision(TME) . Ninety-three patients received abdominopefineal resection(APR) operation, 45 patients received sphincter preserving operation, and 28 patients received local excision. The local recurrence rates were 6. 5% (6/93), 2. 2% (1/45), 17. 9% (5/28), respectively. Histological differentiation and operative procedures were associated with local recurrence. The 5-year survival rates were 91.1% in APR group, 95.5% in sphincter preservation group and 82.6% in local resection group. Univariate analysis revealed that histological differentiation and local recurrence were correlated with prognosis. Multivariate analysis revealed that local recurrence was the most important prognostic factor for Ⅰ stage lower rectal carcinoma. Conclusions Radical resection of Ⅰ stage lower rectal carcinoma has low recurrence rate and better prognosis. Sphincter preserving operation and local excision must be strictly selected in proper patients.
出处
《中华胃肠外科杂志》
CAS
2006年第2期117-120,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
直肠肿瘤
外科手术
复发
预后
Rectal neoplasms
Surgical procedures, operative
Recurrence
Prognosis