A Transanal Technique for Accurately Measuring Distal Resection Margin in Rectal Cancer

經由肛門精確量測直腸癌病患遠端切緣的長度

陳信宏(Hsin-Hung Chen) ； 王瑞和(Jui-Ho Wang) ； 金台明(Tai-Ming King) ； 張敏琪(Min-Chi Chang) ； 許詔文(Chao-Wen Hsu)

《中華民國大腸直腸外科醫學會雜誌》 25卷3期 (2014/09) Pp. 101-105

https://doi.org/10.6312/SCRSTW.2014.25(3).10318

摘要

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。

關鍵字

直腸癌 ； 遠端切緣 ； 經肛門

並列摘要

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.

並列關鍵字

Rectal cancer ； Distal margin resection ； Transanal

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