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International Progress of The Local Excision for Rectal Cancer

早期直腸癌經骶尾局部切除12例分析

目的總結經骶尾行直腸癌局部切除術治療12例早期直腸癌的臨床經驗。方法1993年6月至2002年6月對其中12例早期直腸癌患者行經骶尾局部切除術并分析其治療效果。結果該組病例術后平均住院14.6 d，其中2例術后發生切口感染，經治療后愈合。術后隨訪2~110個月，平均38.2個月，局部復發2例，死亡1例。結論經骶尾局部切除術或局部切除術輔助放療、化療，適用于惡性程度較低的早期直腸癌患者。

十二指腸乳頭腫瘤局部切除術應用

【摘要】 目的 探討十二指腸乳頭腫瘤局部切除術在基層醫院的應用。 方法 2006年4月-2009年10月，對5例十二指腸乳頭腫瘤患者開腹行局部切除術。 結果 5例十二指腸乳頭腫瘤局部切除術均成功完成，無手術死亡和并發癥。 結論 嚴格掌握適應證，局部切除術對十二指腸乳頭腫瘤是一種適于基層開展、安全有效的可選擇術式。

Laparoscopic local excision of duodenal papillary tumor

ObjectiveTo summarize the diagnosis and treatment process of a patient who underwent laparoscopic local excision of duodenal papillary tumor, and to explore the safety and feasibility of this surgery. MethodThe clinicopathologic characteristics and surgical procedure of the patient with duodenal papillary neuroendocrine tumor admitted to the West China Hospital of Sichuan University in June 2021 were retrospectively analyzed. ResultsThe patient underwent the laparoscopic local excision of duodenal papillary tumor + in situ cholangiojejunostomy and pancreaticojejunostomy. The operation lasted about 3 hours, the blood loss was about 20 mL, and the patient exhausted on the 3rd day after the operation. On the 7th postoperative day, the gastric tube was pulled out and oral feeding was started. On the 8th day, the plasma drainage tube was pulled out and the patient was discharged smoothly. There was no duodenal fistula, bleeding, wound infection, and other complications. After 6 months of follow-up, the general condition of this patient was good, and no tumor recurrence or metastasis was found. ConclusionLaparoscopic local excision is an appropriate option for benign or low-grade malignancies involving the duodenal papillary tumor.

Risk factors of lymph node metastasis in T1 rectal cancer

Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.

Mason Operation for Local Excision of Low Rectal Tumor

Objective To study the effectiveness of local excision of low rectal tumor by Mason operation. Methods Twenty-our patients with low rectal tumor underwent Mason operation from 1997-2002 and their information was collected and studied. Results o recurrence was observed in the follow-p period from 5 months to 6 years after operation.Conclusion Mason operation for resection of tumor in low segment of rectum has the advantages of easy manipulation, minimal invasiveness and good exposure in operation.

Local Resection for Rectal Cancer

Benign Duodenum Tumor Excision and Early Nutrition Management （Report of 15 Cases）

目的　探討十二指腸良性腫瘤的手術治療方式及術后早期營養管理的效果。方法　回顧性分析2009年1月至2011年12月期間我科收治的15例十二指腸良性腫瘤患者的臨床資料，根據腫瘤的生長部位及腫瘤大小實施不同的手術方式，術后早期給予腸內營養治療及消化液回輸，觀察術后患者并發癥發生率及術后2個月內的返院情況。結果　15例患者中2例患者腫瘤位于十二指腸乳頭下、直徑2.5cm和2.0cm，2例位于降部與水平部交界處、直徑2.3cm和2.5cm，1例位于十二指腸升部、直徑3.5cm，該5例患者行十二指腸節段切除并空腸吻合術。4例患者腫瘤位于十二指腸乳頭、直徑1.0～2.0cm，3例位于乳頭上緣、直徑1.5～1.8cm，2例位于球部與降部交界處、直徑2.0cm和1.8cm，1例位于十二指腸乳頭下、直徑1.2cm，該10例患者均行腫瘤局部切除術（位于乳頭部的腫瘤同時行乳頭成形術）。圍手術期無死亡病例。1例（1/15）發生胃排空障礙，經禁食、減壓及營養支持治愈出院。術后住院時間為7～10d，平均8d。術后2個月患者均接受隨訪，恢復良好，無返院患者。結論　手術切除是十二指腸良性腫瘤的首選治療手段，手術方式取決于腫瘤的生長部位和大小，術后早期營養管理安全、有效。

Effect of Transanus Local Excision Combined with Radio-Chemotherapy in Gerontal Patients with Low Rectal Carcinoma

目的　 探討老年低位直腸癌經肛門局部切除后加放、化療的臨床意義。方法　對18例年齡≥65歲，腫瘤距肛緣≤6 cm且經病理證實但拒絕Miles術的直腸癌患者行經肛門局部切除； 于術后1個月給予放療（總劑量50 Gy）； 化療： 亞葉酸鈣200 mg、5-FU 400 mg/m2，第1次于術后第1~5 d，每3~4周重復1次，共3~6次。結果　全部病例無手術死亡，術后均有良好的肛門功能。16例獲隨訪，隨訪5年，其中3例局部復發，拒絕再次手術，給予放、化療。死亡12例，其中2例死于遠處轉移，10例死于其他因素。本組患者1年生存率為77.8%（14/18），5年生存率為38.9%（7/18）。結論　對老年低位直腸癌拒絕Miles術的患者行經肛門局部切除加放、化療，療效確切，可提高患者生活質量，延長生存期。

經肛門內鏡微創手術治療直腸腫瘤療效的臨床分析（附26例報道）

目的探討經肛門內鏡微創手術（transanal endoscopic microsurgery，TEM）治療直腸腫瘤的療效及預后，評價其臨床應用價值。 方法回顧性分析2012年8月至2014年11月期間于青島大學附屬醫院行TEM治療的26例直腸腫瘤患者的臨床資料，總結其臨床效果。 結果所有患者的腫瘤病灶均完整切除，切緣行病理學檢查均為陰性。手術時間為（70.7±22.1）min（40～120 min），術中失血量的中位數為9.8 mL（5～30 mL）；術后住院時間為（5.4±2.2）d（4～9 d）。術后病理學檢查示單純直腸腺瘤12例，腺瘤伴低級別上皮內瘤變8例，腺瘤伴高級別上皮內瘤變2例，腺瘤局灶癌變2例，均為T1期；直腸類癌2例。術后發生大便帶血1例，一過性大便失禁2例。26例患者術后均獲訪，隨訪時間的中位數為9個月（6～18個月）。隨訪期間均未出現腫瘤局部復發，未發生控便和排便功能障礙。 結論TEM的術野暴露良好、切除范圍準確、術后恢復快、復發率低，是一種可用于治療直腸腫瘤，特別是位于直腸中上段的良性腫瘤及早期直腸癌的安全而有效的微創手術方法。