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目的探讨影响超低位直肠/直肠肛管癌经括约肌间切除术(Intersphincteric resection,ISR)选择的临床病理因素。方法回顾性分析由同一组专业医师共同完成的超低位直肠癌(肿瘤距肛缘≤5cm或距齿状线≤3cm)切除术患者156例。纳入指标包括:年龄、性别、肿瘤分化程度、肿瘤距肛缘距离、病理TNM分期、术前CS分期和新辅助治疗。结果共有63例患者接受ISR,93例患者未接受此术式。单因素分析表明肿瘤病理T分期(P=0.038)、N分期(P=0.044)和术前CS分期(P<0.001)与ISR选择有关。多因素分期显示肿瘤病理T分期、N分期和CS分期是影响直肠肛管癌ISR选择的独立因素。结论超低位直肠癌患者是否可行经括约肌间切除术与肿瘤局部浸润程度、淋巴结受累情况有关,而与肿瘤距肛缘距离、肿瘤分化程度及新辅助化疗无关。直肠指检仍是决定是否可行经括约肌间切除术的有效方法。
Objective To investigate the clinicopathological factors that influence the selection of intersphincteric resection (ISR) in ultra-low rectal / rectal cancer. Methods A retrospective analysis of 156 patients with ultra-low rectal cancer (tumor ≤5 cm from anus edge or odontoid line ≤3 cm) performed by the same group of specialized physicians was performed. Inclusion indicators include: age, gender, tumor differentiation, tumor margin distance, TNM staging, preoperative CS staging and neoadjuvant therapy. Results A total of 63 patients received ISR and 93 patients did not receive this procedure. Univariate analysis showed that pathological T stage (P = 0.038), N stage (P = 0.044) and preoperative CS stage (P <0.001) were related with ISR selection. Multi-factor staging showed that T-stage, N-stage and CS staging were independent factors affecting ISR selection of rectal cancer. CONCLUSIONS: It is feasible to treat patients with ultra-low rectal cancer via sphincterotomy with local infiltration of tumor and lymph node involvement, but not with the distance of tumor margin, tumor differentiation and neoadjuvant chemotherapy. Digital rectal examination is still a viable alternative for determining the feasibility of an intra-sphincterotomy.