杨晓;吴斌;肖毅;林国乐;牛备战;邱辉忠;
YANG Xiao;WU Bin;XIAO Yi;LIN Guo-le;NIU Bei-zhan;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院 北京协和医学院 北京协和医院基本外科

摘要(Abstract)：

目的探讨直径1² 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12 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1² 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242 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24⁷7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177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1² 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。
Objective To investigate the clinical features of and surgical choices for rectal carcinoids of1- 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 the29 patients who were followed up,the 23 patients with limited submucosal lesions had a 5-year survival rate of95. 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.

关键词(KeyWords)： 直肠肿瘤;类癌;手术;临床结局
rectal neoplasm;carcinoid;surgery;clinical outcome

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 杨晓;吴斌;肖毅;林国乐;牛备战;邱辉忠;
YANG Xiao;WU Bin;XIAO Yi;LIN Guo-le;NIU Bei-zhan;QIU Hui-zhong;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1]汪建平,蔡永华.直肠类癌诊治现状[J].中国实用外科杂志,2012,32:682-684.
• [2]Modlin IM,Lye KD,Kidd M.A 5-decade analysis of 13,715 carcinoid tumors[J].Cancer,2003,97:934-959.
• [3]Jetmore AB,Ray JE,Gathright JB,et al.Rectal carcinoids:the most frequent carcinoid tumor[J].Dis Colon Rectum,1992,35:717-725.
• [4]Tichansky DS,Cagir B,Borrazzo E,et al.Risk of second cancersin patients with colorectal carcinoids[J].Dis Colon Rectum,2002,45:91-97.
• [5]Son HJ,Sohn DK,Hong CW,et al.Factors associated with complete local excision of small rectal carcinoid tumor[J].Int J Colorectal Dis,2013,28:57-61.
• [6]Woodside KJ,Townsend CM Jr,Mark Evers B.Current managementof gastrointestinal carcinoid tumors[J].J Gastrointest Surg,2004,8:742-756.
• [7]朱军,丁健华,赵克,等.直肠类癌预后影响因素分析[J].中国普外基础与临床杂志,2012,19:387-390.
• [8]Shields CJ,Tiret E,Winter DC,et al.Carcinoid tumors of the rectum:a multi-institutional international collaboration[J].Ann Surg,2010,252:750-755.
• [9]Kwaan MR,Goldberg JE,Bleday R.Rectal carcinoid tumors:review of results after endoscopic and surgical therapy[J].Arch Surg,2008,143:471-475.
• [10]Eggenberger JC.Carcinoid and other neuroendocrine tumors of the colon and rectum[J].Clin Colon Rectal Surg,2011,24:129-134.
• [11]Buess G,Kipfmüller K,Hack D,et al.Technique of transanal endoscopic microsurgery[J].Surg Endosc,1988,2:71-75.
• [12]Kumar AS,Coralic J,Kelleher DC,et al.Complications of transanal endoscopic microsurgery are rare and minor:a single institution's analysis and comparison to existing data[J].Dis Colon Rectum,2013,56:295-300.