俯卧折刀位下腹会阴联合切除术治疗T3-4期低位直肠癌的疗效

Therapeutic results of abdominoperineal resection in the prone jackknife position for T3-4 low rectal cancers.

作者信息

Hu Xiang, Cao Liang, Zhang Jian, Liang Pin, Liu Ge

机构信息

Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222 Zhongshan Road, Dalian, 116011, China,

出版信息

J Gastrointest Surg. 2015 Mar;19(3):551-7. doi: 10.1007/s11605-014-2683-1. Epub 2014 Nov 4.

DOI:10.1007/s11605-014-2683-1

PMID:25367808

Abstract

OBJECTIVE

To evaluate the therapeutic results of abdominoperineal resections in the prone jackknife position for T3-4 low rectal cancers.

METHODS

From January 2002 to January 2011, 536 patients with T3-T4 low rectal cancer underwent abdominoperineal resection. Two hundred forty-three were treated in the Lloyd-Davies position and 293 in the prone jackknife position. Clinicopathological data and survival of the two groups were analyzed retrospectively.

RESULTS

Abdominoperineal resections in the prone jackknife position group were associated with significantly less blood loss (124 ± 50.68 vs 210.67 ± 83.32 ml, P < 0.001) and shorter operation times (3.10 ± 1.08 vs 3.82 ± 1.43 h, p = 0.010) than those in Lloyd-Davies position group. The total local recurrence rate is 8.4 % (45/536). The local recurrence rate in the prone jackknife position group was significantly lower than in the Lloyd-Davies position group (5.5 vs 11.9 %, P < 0.001). By multivariate regression analysis, depth of tumor invasion (P = 0.032), CRM (P < 0.001), and position (P = 0.015) were found to be independent risk factors for local recurrence. Multivariate Cox regression survival analysis, lymph node metastasis, and CRM (P < 0.001) were proven to be the major independent prognostic factors for T3-T4 low rectal cancer patients.

CONCLUSIONS

Abdominoperineal resection in the prone jackknife position for T3-T4 low rectal cancers is feasible and has a lower local recurrence.

摘要

目的

评估俯卧折刀位下行腹会阴联合切除术治疗T3 - 4期低位直肠癌的疗效。

方法

2002年1月至2011年1月，536例T3 - T4期低位直肠癌患者接受了腹会阴联合切除术。其中243例采用Lloyd - Davies体位治疗，293例采用俯卧折刀位治疗。对两组患者的临床病理资料及生存情况进行回顾性分析。

结果

与Lloyd - Davies体位组相比，俯卧折刀位组腹会阴联合切除术的失血量明显更少（124±50.68 vs 210.67±83.32 ml，P < 0.001），手术时间更短（3.10±1.08 vs 3.82±1.43 h，p = 0.010）。总局部复发率为8.4%（45/536）。俯卧折刀位组的局部复发率明显低于Lloyd - Davies体位组（5.5% vs 11.9%，P < 0.001）。多因素回归分析发现，肿瘤浸润深度（P = 0.032）、环周切缘（CRM，P < 0.001）及体位（P = 0.015）是局部复发的独立危险因素。多因素Cox回归生存分析表明，淋巴结转移和CRM（P < 0.001）是T3 - T4期低位直肠癌患者主要的独立预后因素。