早期直肠癌的诊治现状与全程监测

doi:10.16139/j.1007-9610.2024.03.03

摘要/Abstract

摘要：

早期直肠癌是指浸润深度局限于黏膜及黏膜下层的任意大小的直肠上皮性肿瘤，无论有无淋巴结转移。不伴局部淋巴结转移的早期直肠癌，局部切除是主要治疗方式之一。内镜黏膜切除术（EMR）、内镜黏膜下剥离术（ESD）、经肛门内镜显微手术（TEM）和经肛门微创手术（TAMIS）等技术的发展，给早期直肠癌的治疗带来了更多的选择。8%~12%的早期直肠癌病人存在局部淋巴结转移，因此仍需接受全直肠系膜切除术（TME）。现行指南推荐，具有高危病理特征的早期直肠癌需追加补救性根治手术。各种微创、低位保肛手术如经自然腔道取标本手术（NOSES）、经肛门全直肠系膜切除术（TaTME）、经括约肌间切除术（ISR）、适形切除功能保肛手术（CSPO）更好地实现了保肛保功能的目标。早期直肠癌总体预后良好，但其全程监测随诊同样重要。早期直肠癌的早诊早治及全程监测理念的革新，内镜技术及外科技术的发展，必将进一步提高早期直肠癌诊疗的规范化。

关键词: 早期直肠癌, 局部切除, 根治术, 全程监测

Abstract:

Early rectal cancer is defined as any size of rectal epithelial tumor with infiltration depth limited to the mucosa and submucosa, regardless of with or without lymph node metastasis. Local resection is one of the main treatment methods for early rectal cancer without local lymph node metastasis. The development of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) has brought more options for the treatment of early rectal cancer. About 8%-12% of early rectal cancer patients have local lymph node metastasis and therefore still require total mesorectal excision (TME). The current guidelines recommend that early rectal cancer with high-risk pathological features requires additional salvage radical surgery. Various minimally invasive and anal sphincter-preserving surgical techniques, such as natural orifice specimen extraction surgery (NOSES), transanal total mesorectal excision (TaTME), intersphincteric resection (ISR), and conformal sphincter-preserving operation (CSPO), have better achieved the goal of anal sphincter preservation and anal function preservation. The overall prognosis of early rectal cancer is good, but full-process surveillance is equally important. With the innovation of early diagnosis, early treatment and full-process surveillance, the development of endoscopic and surgical techniques will further improve the standardization of diagnosis and treatment for early rectal cancer.

Key words: Early rectal cancer, Local resection, Radical surgery, Full-process surveillance

中图分类号:

R735.37

兰平, 陈永乐, 何晓生. 早期直肠癌的诊治现状与全程监测[J]. 外科理论与实践, 2024, 29(03): 197-205.

LAN Ping, CHEN Yongle, HE Xiaosheng. Diagnosis, treatment and full-process surveillance of early rectal cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(03): 197-205.

图/表 1

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