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Local Resection for Rectal Cancer

早期直肠癌经骶尾局部切除12例分析

目的总结经骶尾行直肠癌局部切除术治疗12例早期直肠癌的临床经验。方法1993年6月至2002年6月对其中12例早期直肠癌患者行经骶尾局部切除术并分析其治疗效果。结果该组病例术后平均住院14.6 d，其中2例术后发生切口感染，经治疗后愈合。术后随访2~110个月，平均38.2个月，局部复发2例，死亡1例。结论经骶尾局部切除术或局部切除术辅助放疗、化疗，适用于恶性程度较低的早期直肠癌患者。

十二指肠乳头肿瘤局部切除术应用

【摘要】 目的 探讨十二指肠乳头肿瘤局部切除术在基层医院的应用。 方法 2006年4月-2009年10月，对5例十二指肠乳头肿瘤患者开腹行局部切除术。 结果 5例十二指肠乳头肿瘤局部切除术均成功完成，无手术死亡和并发症。 结论 严格掌握适应证，局部切除术对十二指肠乳头肿瘤是一种适于基层开展、安全有效的可选择术式。

International Progress of The Local Excision for Rectal Cancer

Risk factors of lymph node metastasis in T1 rectal cancer

Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymph vascular infiltration, perineural infiltration, and carcinoma nodule. The univariate analysis and multivariate analysis were done using the Chi-square test and logistic regression model, respectively. Results The rate of LNM in the patients with T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and carcinoma nodule were related to the LNM in the T1 rectal cancer (P<0.050). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and carcinoma nodule are risk factors of LNM in T1 rectal cancer.

Experience of local pancreatectomy in treatment of benign and low-grade malignant pancreatic tumors (clinical data analysis of 45 cases)

ObjectiveTo investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.MethodThe clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.ResultsForty-five patients underwent the local enucleation or resection with negative margin. The pathological results showed that there were 17 cases of solid pseudopapilloma, 5 cases of mucinous cystadenoma, 4 cases of serous cystadenoma, 10 cases of islet cell tumor, 5 cases of nonfunctional neuroendocrine tumor, 4 cases of congenital cyst. There were 6 cases of head of pancreas, 26 cases of body of pancreas, 8 cases of tail of pancreas, 5 cases of uncinate process. The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm. Among them, the diameter was more than 5.0 cm in 9 cases. The incidence of pancreatic fistula after operation was 57.8%, 65.4% was grade A fistula, 34.6% was grade B fistula, and no grade C fistula occurred. The incidence of abdominal infection was 13.3%, incidence of abdominal hemorrhage was 6.7%. There was no secondary diabetes mellitus and pancreatic endo- and exocrine dysfunction, and no death case.ConclusionsPancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients. Although the incidence of pancreatic fistula is high, it is mostly biochemical fistula, and the incidence of serious complications is low.