- 期刊
Clinical Outcome of Abdomino- Anal Resection for Lower Rectal Cancer with Colonic J-Pouch Coloanal Anastomosis Versus Abdominoperineal Resection
對於非常低位之直腸癌，以腹部肛門切除併結腸J-Pouch肛門吻合術與腹部會陰切除術之臨床結果的比較
摘要
背景 永久性腸造口對於低位直腸癌患者而言一直是個夢靨，如何避免永久性腸造口又能達到足夠之腫瘤切除？腹部肛門切除是一個方法。本篇研究即探討對於非常低位之直腸癌，以腹部肛門切除(AAR)併結腸J-Pouch肛門吻合術與腹部會陰切除術(APR)之臨床結果的比較。 方法 從一九九五年一月到一九九八年十二月，共有六十位符合條件之非常低位直腸癌患者接受手術，選擇的條件如下：腫瘤之直徑小於5公分，沒有遠處之轉移，腫瘤之下緣距齒狀線1至3公分。其中23位接受腹部肛門切除併結腸J-Pouch肛門吻合術，37位接受腹部會陰切除術。比較這兩組病患術後之復發、轉移率及存活率。 結果 這兩組患者在年紀、姓別、腫瘤的分期、大小方面並無明顯的差別。平均的追蹤時間是二十四個月。復發／轉移的比率在AAR組為52%，在APR組為35%。而局部復發（會陰及骨盆腔）的比率在AAR組為43%，在APR組為25%，術後一年及兩年的存活率在AAR組分別為95.2%及76.6%，在APR組分別為89.2%及71%。針對較早期的直腸癌患者（腫瘤分期為stage I及stage Iia）來比較，這兩組患者在整個存活率及無復發／轉移存活的比率上並無明顯的差別。 結論 腹部肛門切除術對於較早期的非常低位直腸癌患是合適的手術方法。
並列摘要
Purpose. This retrospective study evaluated the clinical outcome of abdomino-anal resection (AAR) of lower rectal cancer with colonic J-pouch coloanal anastomosis. Methods. Data for a total of 23 patients treated for lower rectal cancer using abdomino-anal resection (AAR) were compared with those of 37 patients treated with abdominoperineal resection (APR). Results. There was no significant difference of the general data and tumor condition between the two groups. The median follow-up time was 24months in both groups. The recurrence/metastasis rate was 52% in the AAR group and 35% in the APR group. The local recurrence (perineum and pelvic wall) rate was 43% in the AAR group and 25% in the APR group. The one year and two year survival rate was 95.2%, 76.6% in the AAR group and 89.2%, 71% in the APR group, respectively. In patients with earlier stage (not later than stage Ⅱa) there was no significant difference in disease-free survival and overall survival between the two groups. Conclusions: The results of this study suggest the use of AAR in patients with earlier stage of very low rectal carcinoma.
延伸閱讀
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