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摘要:
目的 探讨直径1~2 cm直肠类癌的临床特点及手术方式选择。 方法 回顾性分析北京协和医院2000年1月至2012年12月收治的31例直径在1~2 cm之间的直肠类癌患者的临床资料。其中男17例, 女14例; 年龄24~77岁, 中位年龄46岁。 结果 31例患者中, 临床表现为腹部不适、排便次数增多18例(58.1%), 便血2例(6.5%); 余11例患者无症状。本组患者行局部切除术26例, 包括经肛门内镜微创手术19例(61.3%), 经肛门括约肌途径直肠肿物切除术(Mason术)4例(12.9%), 经肛门肿物切除术3例(9.7%); 行根治性切除手术5例(16.1%)。术后病理回报所有病例均为直肠类癌, 病变局限于黏膜下层25例; 浸润肌层6例, 其中淋巴结转移1例。29例患者得到随访, 病变局限于黏膜下层者(n=23)5年生存率为95.7%, 浸润肌层者(n=6)5年生存率为50%(P < 0.001)。 结论 直径1~2 cm直肠类癌, 病变局限于黏膜下层者可行局部切除, 病变侵及肌层者行根治性切除为妥。 Abstract:Objective To investigate the clinical features of and surgical choices for rectal carcinoids of 1-2 cm in diameter. Methods The clinical data of 31 rectal carcinoid patients with tumors of 1-2 cm in diameter who were treated in Peking Union Medical College Hospital between January 2000 and December 2012 were collected and analyzed retrospectively. The selected patients included 17 males and 14 females, aged 24-77 years (median age 46 years). Results Abdominal discomfort and diarrhea(18/31, 58.1%) were the most common symptoms. Two(2/31, 6.5%) patients had hematochezia. The other 11 were asymptomatic. Twenty-six patients underwent local excision: transanal endoscopic microsurgery (TEM) in 19 (61.3%), transsphincteric resection (York-Mason approach) in 4(12.9%), and transanal excision in 3(9.7%).Five (16.1%) patients received radical surgery. Postoperative pathological results showed rectal carcinoid in all the 31 patients, including limited submucosal lesions in 25 cases and muscular invasion in 6. Lymph node metastasis occurred in 1 case. Among the 29 patients who were followed up, the 23 patients with limited submucosal lesions had a 5-year survival rate of 95.7%, significantly higher than that of the 6 patients with muscular invasion(50%, P < 0.001). Conclusion For the rectal carcinoid tumors of 1-2 cm in diameter without muscular invasion, local excision is an appropriate surgical choice; while for those with muscular invasion, radical resection is necessary. -
Key words:
- rectal neoplasm /
- carcinoid /
- surgery /
- clinical outcome
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