Asayama Naoki, Nagata Shinji, Miguchi Masashi, Shigita Kenjiro, Aoyama Taiki, Fukumoto Akira, Mukai Shinichi
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Endosc Int Open. 2020 Feb;8(2):E214-E220. doi: 10.1055/a-1038-3973. Epub 2020 Jan 28.
Rectal tumors are traditionally resected by proctectomy to ensure the achievement of negative margins, an approach associated with an adverse impact on subsequent quality of life due to sequelae such as permanent stoma and urinary and sexual dysfunction. Many studies have now demonstrated that recurrence after local excision of early rectal tumors is significantly higher than would typically be expected. We have developed a new procedure, described herein, that combines local resection with endoscopic submucosal dissection for low rectal tumor. We report four consecutive cases (three submucosal tumors and one tumor with clinical deep submucosal invasion) treated at Hiroshima City Asa Citizens Hospital between January 2009 and March 2018. The mean duration of the procedure was 137 minutes. The en bloc resection and histologically complete resection rates were 100 %. Delayed bleeding and perforation rates were 0 %. Postoperative complications were fever and anal pain (one case each). All patients recovered with conservative therapy. No recurrence was found in any of the four patients during a follow-up period of 56 months. Our combined endoscopic and surgical procedure for low rectal tumors enabled definite negative vertical margins, reduced tumor volume, allowed for accurate pathological diagnosis, preserved rectal function, and aided the decision on additional therapy.
传统上，直肠肿瘤通过直肠切除术进行切除，以确保切缘阴性，然而这种方法会因诸如永久性造口以及泌尿和性功能障碍等后遗症，对后续生活质量产生不利影响。现在许多研究表明，早期直肠肿瘤局部切除后的复发率明显高于通常预期。我们在此描述了一种新的手术方法，该方法将局部切除与内镜黏膜下剥离术相结合用于低位直肠肿瘤。我们报告了2009年1月至2018年3月期间在广岛市阿佐市民医院连续治疗的4例病例（3例黏膜下肿瘤和1例临床诊断为黏膜下深层浸润的肿瘤）。手术平均时长为137分钟。整块切除率和组织学完全切除率均为100%。延迟出血和穿孔率为0%。术后并发症为发热和肛门疼痛（各1例）。所有患者经保守治疗后康复。在56个月的随访期内，4例患者均未发现复发。我们用于低位直肠肿瘤的内镜与手术联合方法能够实现明确的阴性垂直切缘，缩小肿瘤体积，有助于准确的病理诊断，保留直肠功能，并辅助决定是否需要进一步治疗。
