目的 直腸癌病患遠端切緣的長度對於病患是一個重要的預後因子。但是如何準確的量測足夠的切緣長度仍是一個令人困擾的問題,我們在此提出一個手術的方法,使我們可以在直腸癌手術中得到足夠的遠端切緣的長度。方法 從2013年10月至2014年2月之間,我們共選取17名罹患直腸癌的病患,並且於手術進行中利用肛門鏡及3-O vicryl縫線,利用量尺量測我們設定的遠端切緣(至少距離腫瘤大於2公分)並縫合肛門出口,並留下一段縫線長度使我們可以於手術之中利用來確認遠端切緣,之後利用相關統計方法分析各種情況下遠端的切緣長度。結果 我們共選取17位接受低前位切除的直腸癌病患,並比較手術術前量測、標本離體,以及病理福馬林定型後的遠端切緣長度之間的關係。我們發現到經由我們提出的方法量測到的活體距離平均約43.8公厘並且於離體量測時縮減到32.7公厘(縮減比率約25.3%),兩者之間的縮減長度約為11.1公厘。這個縮減的長度在經由福馬林的處裡定型後,還會再度縮減平均7.9公厘,進而達到定型後的平均遠端切緣長度為24.9公厘。所以在活體的遠端切緣長度經由福馬林的定型處理後,整體的縮減長度大約為為切除之前的活體長度的41.9%。結論 對於直腸癌的病患,我們提供了一種可以量測遠端切緣的方式,可以減少遠端切緣不足的可能性,以及減少為了量測足夠的切緣造成的腫瘤過度操作。
Purpose. Adequate distal resection margin (DRM) is an important factor determining the outcome of rectal cancer surgery. Traditionally, DRM is measured intra-abdominally after mesorectal excision. We proposed a new method to achieve sufficient DRM and avoid tumor cell exfoliation-caused bysurgical over-manipulation of the rectum involved with tumor. Material and Methods. Between October 2013 and February 2014, 17 patients (seven males, 10 females; median age: 71.1 yrs (range: 44-85 yrs) with rectal cancer who underwent low anterior resection (15 patients) or colo-anal anastomosis (two patients) received our intra-operative trans-anal technique. We used a plastic anoscopeto expand the anal canal and allow the use of a plastic ruler to measure the distal tumor margin. We then performed purse string suture ligation of the distal margin with 3-O vicryl leaving a sufficient length to use as a guide during surgery. During the colectomy, we performed the resection below the suture site. Results. The average "in vivo" DRM was 43.8 mm +/- SD of 12.7 mm (range: 20-80 mm). Average "ex-vivo" DRM was 32.7 mm +/- SD of 8.85 mm (range: 20-60 mm). The shrinkage rate, comparing "in vivo" with "ex vivo", was 25.3%. The average DRM, as measured by the pathologist (i.e., "in vitro"), was 24.9 mm (range: 15-53 mm). The average shrinkage rate at pathology was 41.9%. Conclusions. Our transanal suture ligation method offers an optimal method to avoid insufficient DRM and tumor cell exfoliation caused by surgical over-manipulation of the rectum involved with tumor.