【作者】 李杰；

【导师】 马冲；

【作者基本信息】 吉林大学 ， 外科学（专业学位）， 2022， 硕士

【摘要】 目的:对比分析局部切除术与根治性手术治疗T1N0M0直肠癌的临床疗效及安全性。方法:本研究收集了2016年1月到2020年6月期间在吉林大学中日联谊医院行手术治疗并经过术后组织病理学检查确定为T1期直肠癌患者的临床资料进行回顾性分析。通过一定的纳入和排除标准进行筛选,最终将符合标准的76例患者纳入研究。按照手术方式不同分为局部切除组和根治手术组。其中局部切除组包括内镜下黏膜切除术(Endoscopic mucosal resection,EMR)、内镜黏膜下剥离术(Endoscopic submucosal dissection,ESD)、经肛门直肠肿物切除术(Transanal excision,TAE)共24例;根治手术组达到筛选标准的患者共52例,均接受腹腔镜直肠癌根治术。对纳入本研究患者的一般资料及肿瘤信息:年龄、性别、体重指数(Body mass index,BMI)、肿瘤大小、肿瘤位置、肿瘤分化程度、术前CEA水平、术前CA19-9水平;手术情况:平均手术时间;术后患者的恢复情况:术后肠道通气时间、术后尿管拔除时间、术后平均住院时间;术后并发症:术后出血、肛门疼痛、肛门失禁、切口感染、肺部感染、尿路感染、吻合口瘘、吻合口狭窄、切口疝等;肛门或人工造口情况的比较;生存评价指标:肿瘤复发率、肿瘤总生存率以及无病生存率等信息进行统计学分析。结果:1.局部切除组与根治手术组在患者的年龄、性别、BMI等一般资料及肿瘤位置、肿瘤大小、肿瘤分化程度、术前CEA水平、术前CA19-9水平等肿瘤信息的差异无统计学意义,因此两组患者具有可比性。2.相比于根治手术组,局部切除组在平均手术时间、术后肠道通气时间、术后尿管拔除时间、术后平均住院时间等方面具有优势。3.对于局部切除组与根治手术组关于手术并发症情况比较,局部切除组中共发生2例并发症,根治手术组共发生15例并发症,两组总并发症发生率的差异具有统计学意义。4.局部切除组与根治手术组患者关于肿瘤复发率、总生存率、无病生存率的比较:局部切除组发生1例局部复发,复发率为4.17%;根治手术组中,1例患者发生肝转移、1例患者发生局部复发,复发率为3.85%。且两组患者在肿瘤总生存率(P=0.9)及无病生存率(P=0.9)等方面差异均无统计学意义。结论:1.对于T1N0M0直肠癌患者,局部切除术可以获得与根治手术相同的安全性与临床疗效;2.局部切除手术在手术时间、术后恢复、手术并发症等方面具有明显优势,同时可以一定程度上避免永久性的结肠造口,有助于改善患者的生存质量;3.对于老年、心肺功能差、不接受根治手术的早期直肠癌患者,局部切除手术可以作为优先选择的治疗方式。更多还原

【Abstract】 Objective:To compare and analyze the clinical efficacy and safety of local excision and radical surgery for T1N0M0 rectal cancer.Methods:In this study,clinical data of patients who underwent surgical treatment and were determined to have stage T1 rectal cancer after postoperative histopathological examination at China-Japan Union Hospital of Jilin University between January 2016 and June 2020 were collected for retrospective analysis.Screening was performed through certain inclusion and exclusion criteria,and 76 patients who met the criteria were finally included in the study.The patients were divided into local resection group and radical surgery group according to different surgical methods.The local resection group included endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and transanal excision(TAE),a total of 24 cases;A total of 52 individuals who met the screening criteria had laparoscopic radical surgery for rectal cancer in the radical surgery group.The following patients’ general data and tumor information were statistically analyzed: age,gender,body mass index(BMI),tumor size,tumor location,tumor differentiation,preoperative CEA level,preoperative CA19-9 level;the related data during surgery: average operation time;postoperative recovery of patients: postoperative bowel ventilation time,postoperative urinary catheter removal time,average postoperative hospitalization time;postoperative complications: postoperative bleeding,anal pain,anal incontinence,incisional infection,pulmonary infection,urinary tract infection,anastomotic fistula,anastomotic stricture,incisional hernia,etc.;comparison of anal or artificial stoma conditions;survival evaluation indexes: tumor recurrence rate,overall survival rate,and disease-free survival rate,etc.Results:1.There were no statistically significant differences in the general information of patients such as age,gender,BMI,and tumor information such as tumor location,tumor size,tumor differentiation degree,preoperative CEA level,and preoperative CA19-9 level between the local resection group and the radical surgery group,so the two groups were comparable.2.In terms of average operative time,postoperative bowel ventilation time,postoperative ureter removal time,and average postoperative hospitalization time,the local resection group outperformed the radical surgery group.3.In the comparison of surgical complications between the local resection group and the radical surgery group,a total of 2 complications occurred in the local excision group and 15 complications occurred in the radical surgery group,with a statistically significant difference in the total complication rate between the two groups.4.Comparison of the tumor recurrence rate,overall survival rate,and disease-free survival rate between the local resection group and the radical surgery group: One case of local recurrence occurred in the local resection group,with a recurrence rate of 4.17 percent;one patient had liver metastasis and one patient had local recurrence in the radical surgery group,with a recurrence rate of 3.85 percent.In terms of overall tumor survival(P=0.9)and disease-free survival(P=0.9),there was no statistically significant difference between the two groups.Conclusion:1.Local excision can achieve the same safety and clinical outcomes as radical surgery in patients with T1N0M0 rectal cancer.2.Local resection has significant advantages in terms of operative time,postoperative recovery and surgical complications,and permanent colostomy can be avoided to a certain extent,which helps to improve the quality of survival of patients.3.For patients with early stage rectal cancer who are elderly,have poor cardiopulmonary function and do not wish to undergo radical surgery,local excision can be the preferred treatment option.更多还原