Tacke W, Paech S, Kruis W, Stuetzer H, Mueller J M, Ziegenhagen D J, Zehnter E
Medizinische Klinik I, Universität Köln, Germany.
Dis Colon Rectum. 1993 Apr;36(4):377-82. doi: 10.1007/BF02053943.
The results of different treatment modalities in 196 patients with rectal carcinoma were analyzed. Patients were treated by palliative endoscopic laser therapy (n = 37), palliative surgery (n = 42), and curative surgery (n = 117). Laser therapy was successful for recanalization of the stenosis with 1.3 (range, one to five) sessions. Bleeding stopped always after a single session. If necessary, treatment was repeated monthly. Good results were seen in 35/37 patients (95 percent). They received an average of four sessions during their remaining lifetime, the median of which was eight months. No morbidity and no therapy-related mortality occurred. Palliative surgery (expanded and restricted resections) showed good results in 41/42 patients (98 percent). Morbidity was 3/42 (7 percent); mortality was 1/42 (2 percent). The median survival was 14 months for local surgical treatment and 6.3 months for deep anterior rectal resection and for abdominoperineal (Dixon's) resection. No significant difference (P = 0.15) in survival times between the palliatively treated patient groups could be detected. Survival prognosis was determined by tumor stage and outcome. In the curative (outcome R0) resection patients, morbidity and mortality were each 9/117 (8 percent). The three-year survival rate was 80 percent. If curative resection is impossible, laser therapy should be considered as an alternative to palliative surgery because of less hospitalization and seemingly less side effects. The decision on the kind of palliation in patients with rectal carcinoma should be made with regard to the patient's quality of life.
分析了196例直肠癌患者不同治疗方式的结果。患者接受了姑息性内镜激光治疗（n = 37）、姑息性手术（n = 42）和根治性手术（n = 117）。激光治疗通过1.3次（范围为1至5次）治疗成功使狭窄再通。单次治疗后出血总能停止。如有必要，每月重复治疗。35/37例患者（95%）效果良好。他们在剩余生命中平均接受4次治疗，中位数为8个月。未发生并发症及与治疗相关的死亡。姑息性手术（扩大和局限性切除）在41/42例患者（98%）中显示出良好效果。并发症发生率为3/42（7%）；死亡率为1/42（2%）。局部手术治疗的中位生存期为14个月，直肠前深部切除和腹会阴（迪克森氏）切除的中位生存期为6.3个月。在接受姑息治疗的患者组之间，未检测到生存时间的显著差异（P = 0.15）。生存预后由肿瘤分期和结果决定。在根治性（结果R0）切除患者中，并发症和死亡率均为9/117（8%）。三年生存率为80%。如果无法进行根治性切除，由于住院时间较短且副作用似乎较少，激光治疗应被视为姑息性手术的替代方案。直肠癌患者姑息治疗方式的决定应考虑患者的生活质量。
