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題名 | Using a Simple Surgical Skill to Forecast a Safe Distal Resection Margin for Low Anterior Resection of Rectal Cancer=使用一個簡單手術技巧在直腸癌低前位切除手術中預測安全的腫瘤遠端手術切除長度 |
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作者姓名(中文) | 王永昌; 王瑞和; 金台明; 張敏琪; 許詔文; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷期 | 27:1 2016.03[民105.03] |
頁次 | 頁1-6 |
分類號 | 416.245 |
關鍵詞 | 手術遠端切除長度; 低前位切除手術; 直腸癌; Surgical distal resection margin; Low anterior resection; Rectal cancer; |
語文 | 英文(English) |
中文摘要 | 目的:使用簡單的手術技巧在大腸直腸癌低前位切除手術中預測安全的腫瘤遠端手術切除範圍。方法:從2012年10月至2013年6月間,收集第一期至第四期直腸癌患者在高雄榮民總醫院外科部大腸直腸外科由同一位醫師開刀的病例。在手術當中,我們將直腸擺放至正常位置並再腫瘤下方邊緣處利用電刀製造一個記號。我們在距離記號下方在製造一個手術切除範圍的記號(高位直腸癌至少距離腫瘤下緣3公分、中低位直腸癌至少距離腫瘤下緣3公分)並紀錄遠端邊緣長度。之後切除腫瘤後,立即切開直腸標本,由腸道內部測量並紀錄腫瘤下緣至切口處長度。最後再由病理報告查詢並紀錄病理報告中腫瘤的遠端邊緣長度。我們比較術中、術後及病理的遠端邊緣長度的差異。結果:共70直腸癌病患在研究期間內接受手術,38位病患由科內其他醫師手術,2位病換因接受過手術前化學並放射線治療遭到剔除,最後共30位病患(25位男性、5位女性)被收錄於研究中。17個腫瘤位於高位結腸,13個腫瘤位於中低位結腸。手術中測量得到的活體平均遠端切除長度為36.3 ± 8.50 mm,病理報告中的平均遠端切除長度為21.0 ± 9.37 mm。平均檢體收縮比率為44.1%。結論:依本研究的解果,我們預先於高位直腸癌腫瘤邊緣到切口處預留至少三公分範圍,而低位直腸癌腫瘤邊緣到切口處預留至少兩公分,可以在獲得病理學上完全切除及至少一公分病理遠端切除長度。 |
英文摘要 | Purpose. This study was designed to forecast a safe distal resection margin while performing low anterior resection of rectal cancer. Methods. We included patients with stage I to VI rectal cancer who had been operated on by a single surgeon at Kaohsiung Veterans General hospital between October 2012 and June 2013.We created a mark at the lower border of the tumor. Then, we measured the length (for the upper rectum, 3 cm; for the mid-low rectum, 2 cm) from the lower border in anatomical position as a resection mark. We cut the rectum from the resection mark and then removed the specimen. We measured the distal resection margin of the specimen.We followed the distal resection margin of specimens in pathology reports. We compared the difference between these distal resection margins. Results. Low anterior resection was performed for 70 patients during the study. Other surgeons treated 38 patients who were excluded. Two patients were excluded because they had received neoadjuvant chemoradiation therapy. Totally, 30 patients were included in the study (25 men and 5 women). Seventeen tumors were located in the upper rectum and 13 tumors in the mid-low rectum. The mean distal resection margin (in vivo) was 36.3 ± 8.50 mm. The mean distal resection margin (pathology) was 21.0 ± 9.37 mm. The rate of specimen shrinkage was 44.1%. Conclusion. By measuring the distal resection margin of low anterior resection, we can obtain R0 resection and forecast at least a 1-cm safe pathologic distal resection margin. |
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