经肛门内镜切除直肠癌的并发症

R. Nikitenko, K. Vorotyntseva, S. P. Degtyarenko, O. M. Stepanovichus
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引用次数: 1

摘要

目标。目的:探讨经肛门内镜切除直肠癌患者术中及术后并发症的发生情况,减少并发症的发生。材料和方法。2009年至2021年期间,在敖德萨地区临床医院,184名直肠癌患者接受了经肛门内窥镜切除手术。患者年龄42 ~ 86岁。将患者分为两组。第一组90例患者的肿瘤直接诊断为I期(T1-2N0M0)。第二组94例确诊为直肠癌分期ІІ (T3N0M0)。结果。所有184例患者均无脓毒症、血栓栓塞和泌尿系统并发症,以及严重的术中并发症和死亡率。患者平均静止时间为(3.4±1.7)天(2 ~ 6天)。肿瘤下缘距肛管的平均距离为(9.5±4.2)cm (5 ~ 16 cm),肿瘤平均尺寸为(2.8±1.7)cm (1.5 ~ 4 cm)。在研究组织学调查结果时,注意到所有患者的肿瘤都是根据肿瘤学技术在健康组织边界切除的。随访时间为12 ~ 60个月,第一组有12例(13.3%)患者直肠肿瘤复发。癌症复发曾发生在拒绝化疗和放疗的患者中。复发的患者再次手术,采用经典低位直肠前切除术加全肠系膜切除术。结论。术前进行新辅助化疗和放疗时,肿瘤尺寸明显减小,经肛门内镜切除时的内和术后并发症数量也明显减少。直肠癌的预后直接取决于局部“前哨”淋巴结转移的存在。
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Complications of transanal endoscopic resection in cancer recti
Objective. To study іntra- and postoperative complications in transanal endoscopic resection in patients, suffering cancer recti and to reduce this quantity. Materials and methods. Through the period 2009 - 2021 yrs on the base of Odessa Regional Clinical Hospital 184 patients, suffering cancer recti, were operated, using transanal endoscopic resection. The patients’ age was from 42 to 86 yrs old. The patients were distributed into two groups. In 90 patients of the first group the cancer recti diagnosis of stage I (T1-2N0M0) was established. In 94 patients of the second group the diagnosis of cancer recti stage ІІ (T3N0M0) was established. Results. Purulent-septic, thromboembolic and urological complications were absent in all 184 patients, as well as severe intraoperative complications and mortality. The average stationary stay of the patients have constitited (3.4 ± 1.7) days (from 2 to 6 days). The average lower edge of the tumour was situated at a distance (9.5 ± 4.2) cm (from 5 to 16 cm) from the anal channell, and the average dimensions of tumour - (2.8 ± 1.7) cm (from 1.5 to 4 cm). While studying of the histological investigations results there was noted, that in all the patients the tumour was excised in the healthy tissues borders in accordance to oncological technique. Period of follow-up have constituted from 12 to 60 mo. Cancer recti recurrence was revealed in 12 (13.3%) patients of the first group. Cancer recurrence have had occur in patients, who have rejected from conduction of chemo- and radiotherapy. The patients with recurrences were reoperated, using classic low anterior rectal resection with total mesorectumectomy. Conclusion. While conduction of preoperative neoadjuvant chemo- and radiotherapy the tumour dimensions are reduced significantly, as well as quantity of іntra- and postoperative complications in performance of transanal endoscopic resection. The disease prognosis for cancer recti depends directly on presence of metastases in regional «sentinel» lymphatic nodes.
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