Bleday R
Division of Colon and Rectal Surgery, Beth Israel-Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 3A, Boston, Massachusetts 02215, USA.
World J Surg. 1997 Sep;21(7):706-14. doi: 10.1007/s002689900295.
The prospect of treating a rectal cancer often leads to significant fear among patients because of the possibility of a permanent colostomy. Although radical resection, in particular abdominoperineal resection, has been used effectively for rectal cancer treatment, other techniques such as local excision with or without adjuvant therapy have been used with significantly less morbidity than that of the abdominoperineal resection, with excellent cure rates. There are essentially three local excision techniques that can be used to remove a small rectal cancer completely. Selection criteria are critical for choosing the appropriate patient for these techniques. Tumors must be less than 4 cm in diameter and take up less than 40% of the rectal wall circumference. They also need to be relatively close to the dentate line and have no evidence of any invasion into the mesorectum or perirectal nodes. Preoperative staging with endorectal ultrasonography, computed tomography, and digital examination helps select appropriate patients. Retrospective series have shown significant success using local excision techniques, with local recurrence rates ranging from 0% to 11% for early-stage lesions. Prospective series have shown similar recurrence rates. Postoperative function with or without adjuvant therapy has not been adequately documented along with quality of life and must be part of any future reports on local excision techniques as well as all rectal cancer treatment studies. Local excision does, however, seem to provide adequate treatment in well selected patients and provides a less morbid alternative to the treatment of rectal cancer than radical resection, particularly abdominoperineal resection, which obligates the patient to a permanent colostomy.
由于存在永久性结肠造口术的可能性，直肠癌的治疗前景常常使患者产生极大的恐惧。尽管根治性切除术，尤其是腹会阴联合切除术，已被有效地用于直肠癌治疗，但其他技术，如局部切除联合或不联合辅助治疗，其发病率明显低于腹会阴联合切除术，且治愈率很高。基本上有三种局部切除技术可用于完全切除小的直肠癌。选择标准对于为这些技术选择合适的患者至关重要。肿瘤直径必须小于4厘米，占据直肠壁周长的比例小于40%。它们还需要相对靠近齿状线，且没有任何侵犯直肠系膜或直肠周围淋巴结的证据。术前通过直肠内超声、计算机断层扫描和指诊进行分期有助于选择合适的患者。回顾性系列研究表明，使用局部切除技术取得了显著成功，早期病变的局部复发率在0%至11%之间。前瞻性系列研究也显示了相似的复发率。关于有无辅助治疗的术后功能以及生活质量尚未有充分记录，这必须成为未来任何关于局部切除技术以及所有直肠癌治疗研究报告的一部分。然而，对于精心挑选的患者，局部切除似乎能提供充分的治疗，并且与根治性切除术，尤其是腹会阴联合切除术相比，它为直肠癌治疗提供了一种发病率较低的替代方法，腹会阴联合切除术会使患者必须接受永久性结肠造口术。
