Treatment of Advanced Low Rectal Cancer-Oncological and Functional Consideration

進展性低位直腸癌之治療

林楨國(Jen-Kou Lin)

《Formosan Journal of Surgery》 42卷2期 (2009/04) Pp. 72-77

https://doi.org/10.29833/FJS.200904.0002

摘要

進展性低位直腸癌，病情特殊，癌瘤深藏於骨盆腔，癌細胞易直接侵犯到鄰近組織或向骨盆腔側壁沿淋巴腺轉移。癌瘤易有局部及遠處復發。
全直腸旁組織切除目前已公認爲直腸癌切除之標準技術。骨盆腔側壁淋巴廓清術雖可降低復發率，但因手術時間長、出血多，且易有泌尿及性功能障礙，較難爲病人接受。先作術前化療放射合併治療再手術，爲目前治療進展性低位直腸癌之標準作法，可以有效的降低局部復發率，甚至提高存活率。
低位直腸癌切除後常發生頻便、急便、失禁情況。解決之道爲使用J型結腸造袋一肛門吻合術。
未來仍有許多問題待解決，例如如何選擇真正需要術前放射治療之病人？哪些病人之癌瘤是放射治療有效的？需不需要以及如何使用術後化學治療均有待進一步研究。

並列摘要

The treatment of mid-and low rectal cancer is a challenging issue. Lateral spread of cancer cells to the pelvic side wall, sphincter preservation technique in a narrow pelvis, ultra-low ananstomosis, a high local recurrent rate, and unsatisfactory anorectal function of low anastomosis are all problems which should be solved.
Total mesorectal excision resection is now the standard procedure. Lateral pelvic side wall lymph node dissection is not widely accepted as a routine procedure because of high morbidity. Now it is largely replaced by preoperative CCRT (concurrent chemoradiotherapy). Construction of a colon pouch for ultra-low anastomosis is well accepted for improvement of anorectal function after resection for lower rectal cancers.

並列關鍵字

rectum ； carcinoma ； chemo-radiotherapy ； J-pouch