Nakagoe Tohru, Sawai Terumitsu, Tsuji Takashi, Hidaka Shigekazu, Tanaka Kenji, Shibasaki Shin-ichi, Nanashima Atsushi, Yamaguchi Hiroyuki, Yasutake Toru
First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Int Surg. 2004 Jan-Mar;89(1):10-4.
An additional resection is indicated when colorectal polyps resected by colonoscopy reveal T1 carcinoma with unfavorable histology (no free margin or having risk factors for lymph node metastasis). We describe our experience with this type of surgery with the minilaparotomy approach (< or = 7 cm). This prospective study included 19 consecutive patients between 1997 and 2001. Specimens resected by colonoscopy revealed T1 carcinomas with one of the following histological types: inadequate excision (no free margin), lymph-vascular invasion, histologic grade III, or sm2/sm3 (submucosal invasion greater than 200-300 microm from the muscularis mucosa). The minilaparotomy approach included 15 colectomies and 4 anterior resections. Median length of minilaparotomy was 7 cm (range, 4-7 cm). Median number of lymph nodes removed was 11 (range, 7-21 lymph nodes). Median proximal and distal margins were 9.0 (range, 5.2-17.5 cm) and 8.5 cm (range, 2.0-11.5 cm), respectively. The patients quickly returned to normal function without morbidity and mortality. Five (26.3%) had a residual carcinoma within the bowel wall, and one (5.3%) had lymph node metastasis. At a median follow-up of 33.6 months, one patient (5.3%) developed local recurrence and subsequent distant metastasis. The minilaparotomy approach is suitable for an additional operation following colonoscopic polypectomy for T1 carcinoma, thus providing a minimally invasive alternative to conventional laparotomy.
当结肠镜切除的大肠息肉显示为组织学特征不佳的T1期癌（切缘不净或有淋巴结转移风险因素）时，需进行额外切除。我们描述了采用小切口剖腹术（切口长度≤7 cm）进行此类手术的经验。这项前瞻性研究纳入了1997年至2001年间连续的19例患者。结肠镜切除的标本显示为T1期癌，组织学类型如下：切除不充分（切缘不净）、淋巴管侵犯、组织学III级或sm2/sm3（黏膜下侵犯距黏膜肌层超过200 - 300微米）。小切口剖腹术包括15例结肠切除术和4例直肠前切除术。小切口剖腹术的中位长度为7 cm（范围4 - 7 cm）。切除淋巴结的中位数量为11个（范围7 - 21个淋巴结）。近端和远端切缘的中位长度分别为9.0 cm（范围5.2 - 17.5 cm）和8.5 cm（范围2.0 - 11.5 cm）。患者迅速恢复正常功能，无并发症和死亡。5例（26.3%）肠壁内有残留癌，1例（5.3%）有淋巴结转移。中位随访33.6个月时，1例患者（5.3%）发生局部复发并随后出现远处转移。小切口剖腹术适用于结肠镜息肉切除术后针对T1期癌的额外手术，从而为传统剖腹术提供了一种微创替代方法。
