CAJ | 학술논문

目的：探讨采用痔上黏膜环形切除（ PPH）钉合器治疗高龄中低位直肠癌的可行性及安全性。方法对26例距离肛门2～7 cm，直径0．5～3．0 cm的直肠癌患者使用PPH钉合器行局部切除，对病灶组织进行连续病理切片检查，以确认切缘无癌细胞残留。结果26例肿瘤切除率为100％，手术时间20～50 min，术后吻合口出血1例，无吻合口瘘和直肠周围感染。术后病理诊断：高分化腺癌13例，中分化腺癌9例，低分化腺癌4例。吻合口愈合良好，术后住院3～5（4．0±0．7）d。分别随访0．5～1年，2例于术后半年局部复发，再次采用PPH钉合器行局部切除；2例术后1年全身广泛转移，对症治疗后3个月内死亡；2例死于肺心病，2例死于高血压脑梗死；20例生存≥1年。结论 PPH钉合器治疗高龄中低位直肠癌是一种有效、安全、简便和术后并发症少的微创治疗方法。
목적：탐토채용치상점막배형절제（ PPH）정합기치료고령중저위직장암적가행성급안전성。방법대26례거리항문2～7 cm，직경0．5～3．0 cm적직장암환자사용PPH정합기행국부절제，대병조조직진행련속병리절편검사，이학인절연무암세포잔류。결과26례종류절제솔위100％，수술시간20～50 min，술후문합구출혈1례，무문합구루화직장주위감염。술후병리진단：고분화선암13례，중분화선암9례，저분화선암4례。문합구유합량호，술후주원3～5（4．0±0．7）d。분별수방0．5～1년，2례우술후반년국부복발，재차채용PPH정합기행국부절제；2례술후1년전신엄범전이，대증치료후3개월내사망；2례사우폐심병，2례사우고혈압뇌경사；20례생존≥1년。결론 PPH정합기치료고령중저위직장암시일충유효、안전、간편화술후병발증소적미창치료방법。
Objective To explore the feasibility and safety of the procedure for prolapse and hemorrhoids (PPH)stapler in mid-low site rectal cancer operation in aged patients .Methods 26 aged patients suffering from rectal cancers with the size of 0.5 cm to 3.0 cm in diameter locating 2 cm to 7 cm above the anal verge received local resection with PPH stapler in which continuous pathological sections were made to exclude the residues of cancer cell along the cutting edge .Results The successful rate of tumor resection was 100%;the operation duration lasted from 20 minutes to 50 minutes;anastomotic bleeding after operation occurred in 1 case;no anastomotic leak or perianal infection was found;postoperative pathological study showed that out of the 26 cases,13 ones were well differentiated adenocarcinoma ,9 moderate differentiated and 4 poor differentiated;the anastomosis healed well ,and length of stay was 3-5 d( averagely 4.0 ±0.7 d);follow-up lasted from 6 months to 1 year;2 cases had reoccurrence and received the operation again;2 cases suffered from extensive metastasis and died after symptomatic treatment for 3 months;2 cases died of cor pulmonale and 2 died of hypertensive cerebral infarcts;20 survived for more than 1 year.Conclusions PPH stapler provides a simple ,safe,effective micro-invasive therapy for aged patients with mid-low rectal cancer .