直肠绒毛状腺瘤经括约肌途径切除的方法评价

目的　探讨经括约肌途径手术切除直肠绒毛状腺瘤的安全性和价值。方法　对 15例中下段直肠绒毛状腺瘤采用经括约肌途径手术切除 ,术中根据病变切除的需要 ,对肛门括约肌进行了部分至完全的切断。结果　 15例患者均成功地保留了肛门和大便控制功能。发生术后并发症 5例 ,其中骶前间隙感染 3例 ,吻合口漏 2例。随访中有 2例患者出现吻合口复发 ,3例患者诉坐位时会阴部疼痛。结论　经括约肌途径直肠手术是安全可行的 ,只要术毕细致重建括约肌即可。经括约肌途径手术是治疗较大的中低位直肠绒毛状腺瘤的 1种非常有价值的手术方式     

早期直肠癌局部切除32例分析

目的 探讨中低位直肠癌经肛局部切除的适应证。方法 回顾分析本院１９９４年１月～１９９５年１２月经肛局部切除的中低位直肠癌病人３２例。结果 粘膜癌，粘膜下层癌且直径≤２ｃｍ者无例复发。直径〉２．５ｃｍ的粘膜下层癌３例出现局部复发，２例为低分化腺癌，１例为中分化腺癌。结论 经肛局部切除可作为早期中低位直肠癌的一种外科治疗方案，但应严格掌握适应证。     

直肠中下段癌手术治疗67例的经验体会

目的：本文报告手术治疗直肠中下段癌67例的经验体会。方法：26例低位直肠癌患者行直肠癌根治超低位吻合术。用吻合器行低位直肠癌对端吻合20例，2例直肠癌患者行局部切除术，2例直肠癌患者行前切除，结肠拖出术，均成功保留了肛门。17例患者行Miles手术．术后配合化疗，放疗，还有中医中药和免疫治疗等。结果：手术并发症，术后肠梗阻4例，均经保守治疗而愈。1例低分化腺癌并伴肺转移患者，术后1mo死亡外，无手术死亡。均经随访，局部复发4例(4／67.59％)，3a生存率为(5l／67)76．11％，5a生存率为(46／67)68．65％。结论：近年来，直肠中下段癌肿的手术出现了各种各样的保肛手术。但我们认为为保证手术的彻底性，应严格掌握适应症，为提高效果，直肠癌的综合治疗是直肠癌治疗的基本模式之一，目前手术配合化疗，放疗，还有中医中药和免疫治疗等均已成为综合治疗手段，能提高疗效。     

经括约肌低位直肠肿瘤切除的体会

采用经括约肌经路行低位直肠肿瘤切除３６例，其中腺瘤１６例，腺瘤癌变９例，直肠癌１０例，类癌１例，术后切口感染６例，吻合口瘘４例，无肛门失禁。作者简述了手术方法，认为此手术损伤小，显露好，操作简单，不损害肛门功能，并针对术后常见并发症和局部复发的预防进行讨论。     

经括约肌低位直肠肿瘤切除的体会(附36例报告)

采用经括约肌经路行低位直肠肿瘤切除36例，其中腺瘤16例，腺瘤癌变9例，直肠癌10例，类癌1例。术后切口感染6例，吻合口瘘4例，无肛门失禁。作者简述了手术方法，认为此手术损伤小，显露好，操作简便，不损害肛门功能，并针对术后常见并发症和局部复发的预防进行讨论。     

大肠腺瘤癌变的处理

报告49例大肠腺瘤与癌变的关系及大肠腺瘤癌变的处理。男性26例，女性23例，平均年龄43．7岁，其中癌变14例，癌变率为28．6％。脉瘤癌变与腺癌的大小、部位、腺癌的数目、组织学类型及病人年龄等因素有关。＜1cm腺癌未发生癌变，≤2cm的癌变率为55％，直肠及乙状结肠的腺癌易恶变。管状腺瘤、绒毛状腺癌、管状绒毛状腺癌的癌变率分别为22．7％、41．2％、20％，绒毛状腺癌最易癌变。癌变腺癌的术式选择应根据癌变浸润深度、病理组织分类、癌细胞分化程度、切缘是否有癌残留以及淋巴管和静脉是否有癌浸润等决定。     

误诊为直肠粘膜低分化腺癌的恶性黑色素瘤一例

误诊为直肠粘膜低分化腺癌的恶性黑色素瘤一例姜英患者，女，４３岁，半年前因大便带血在某地区医院就诊。术后病理诊断为直肠粘膜低分化腺癌侵入粘膜下层。术后三个月，发现全身多发性结节，经化疗后患者全身结节呈进行性增大无痛及发热。Ｂ超：肝区、胃、胰体部及右肾...     

直肠中段恶性肿瘤切除、乙状结肠经肛管拖出一期吻合术

我院于1979年以来对直肠中段恶性肿瘤采用在根治的前提下、保留内外括约肌与自然肛门。对直肠肿瘤经腹切除,乙状结肠经肛管拖出一期吻合术治疗80例。近期疗效尚好,无手术死亡。本组直肠癌64例,直肠平滑肌肉瘤2例,直肠绒毛状腺瘤癌变6例,直肠乳头状瘤恶变3例,结直肠多发性息肉癌变4例,直肠巨大腺瘤癌变1例。男性45例、女性35例,     

经肛内外括约肌间切除术治疗超低位直肠癌的保肛效果观察

目的 探讨经肛内外括约肌间切除术(ISR)联合经腹全直肠系膜切除术(TME)及经肛结肠肛管吻合术治疗超低位直肠癌的保肛效果.方法 经肛ISR联合经腹TME及经肛结肛吻合术治疗34例无肛门外括约肌受侵的超低位直肠癌患者,术后进行肛门功能训练及功能评价.结果 34例患者远切缘距肿瘤下缘的中位距离为2.3 cm.病理类型为腺癌28例(其中高分化11例,中分化17例),乳头状癌1例,绒毛状腺瘤癌变5例.病理TNM分期Ⅰ期28例,Ⅱ a期1例,Ⅲa期4例,Ⅲb期1例.术后吻合口狭窄3例,吻合口裂开2例,直肠阴道瘘2例.术后早期肛门控便能力明显下降,术后6～12个月肛门功能逐渐恢复.术后5个月吻合口复发1例,术后40个月肝转移1例.结论 在严格掌握适应证的前提下,经肛ISR联合经腹TME及经肛结肠肛管吻合术符合肿瘤根治性原则,并保留了肛门功能,是一种超低位直肠癌保肛的有效手术方法.     

大肠腺瘤癌变的处理

报告４９例大肠腺瘤与癌变的关系及大肠腺瘤癌变的处理。男性２６例，女性２３例，平均年龄４３．７岁，其中癌变１４例，癌变率为２８．６％。腺瘤癌变与腺瘤的大小、部位、腺瘤的数目、组织学类型及病人年龄等因素有关。〈１ｃｍ腺瘤未发生癌变，≥２ｃｍ的癌变率为５５％，直肠及乙状结肠的腺瘤易恶变。管状腺瘤、绒毛状腺瘤、管状绒毛状腺瘤的癌变率分别为２２．７％、４１．２％、２０％，绒毛状腺瘤最易癌变。癌变腺瘤的术式选     

早期低位直肠癌局部切除23例疗效分析

背景与目的:目前,早期低位直肠癌经肛门局部切除术越来越受到重视,因为它可以达到与开腹根治术类似的疗效。本研究目的是探讨早期低位直肠癌局部切除的疗效。方法:回顾性分析1989年2月～1999年4月间我院局部切除早期低位直肠癌23例的临床资料。结果:(1)12例为直肠腺癌,11例为腺瘤恶变;(2)23例中T0期17例,T1期6例;(3)有3例局部复发,其中2例再次经肛门局部扩大切除治愈,另外1例经腹会阴联合切除术;(4)本组病例术后随访均超过5年,5年生存率为95.65%。结论:只要严格掌握手术适应证,局部切除治疗早期直肠癌可取得较好的疗效,是一种切实可行的方法。     

Endocavitary irradiation for rectal cancer and villous adenomas

Endocavitary irradiation has been used for rectal adenocarcinoma and villous adenoma at St. Joseph's Hospital, Milwaukee, Wisconsin since 1978. The 52 patients treated since that time include 32 patients with adenocarcinoma, 19 patients with villous adenoma, and 1 patient with an adenomatous polyp and associated atypia. The average age of these patients (70.5 years) was a full decade older than the average age of all rectal cancer patients. The treatment was administered by a superficial contact machine with most patients receiving 80 Gy over four treatments in a period of 1.5 months. The overall local recurrence rate was 24% in the cancer group and 32% in the villous adenoma group. The 1-, 2-, and 3-year determinate disease-free survival rates were 90.4%, 78.6%, 74.2% and 80.4%; 60.3%, 45.2% for invasive adenocarcinoma and villous adenoma patients, respectively. There was no mortality and very little morbidity associated with the treatment. It is concluded that endocavitary irradiation is an effective alternative to surgery for the treatment of rectal cancer in selected cases. However, villous adenomas do not respond as well. Better results may be obtained for this group of patients by higher doses than were used in this study.     

影响低位直肠癌局部切除选择的因素分析

目的探讨低位直肠癌局部切除选择的影响因素。方法回顾性分析101例局部切除治疗低位直肠癌患者的临床资料。Kaplan-Meier法计算生存率,并对预后进行单因素及多因素分析。结果经肛门切除91例,经骶骨切除9例,经阴道切除1例,并发症发生率为5.9%,全组无手术死亡病例。术前放疗5例,术后放疗34例。5年生存率为91.0%,Tis、T1、T2及T3或T4病变的5年生存率分别为100%、92.6%、77.1%和83.3%;局部复发率为15.8%。单因素分析显示,肿瘤的侵袭深度、直径>3 cm、有脉管瘤栓、溃疡型癌、放射治疗和局部复发与预后有关(P<0.05)。多因素分析显示,肿瘤直径>3 cm、局部复发是影响预后最重要的因素(P<0.05)。结论低位直肠癌病理为高中分化、直径≤3 cm、无脉管瘤栓的T1病变及原位癌,是局部切除术的合理适应证。     

Intraluminal ultrasound of rectal tumours: a prerequisite in decision making.

The use of intraluminal ultrasound (IUS) as a staging technique was evaluated in 58 patients with a rectal tumour. Thirty-four patients had a rectal carcinoma, four had a local recurrence after a previous anterior resection and 20 other patients had a villous adenoma. IUS assessment of rectal wall invasion, infiltration into adjacent organs, and the presence of perirectal lymph node involvement was compared with the definitive histological findings. In 90% of all patients the pre-operative local tumour staging was predicted correctly. In 38 patients with a rectal carcinoma the overall accuracy for the T grade was 84%. The sensitivity for the detection of perirectal fat infiltration was 91%, with a specificity of 70% and a negative predictive value of 78%. The accuracy in predicting direct infiltration into adjacent organs was 100% (n = 5). In the four patients with a local recurrence, the diagnosis was suspected by means of IUS and confirmed by biopsies. Extraluminal tumour growth was predicted correctly in all cases, with extension into the coccygeal bone in one patient. IUS identified lymph nodes in 29 of 38 cases, with a sensitivity of 57% and a specificity of 76%. All 20 villous adenomas were correctly staged as non-infiltrative tumours. After transmural excision, three adenomas proved to contain a completely removed T1 carcinoma. IUS is the most accurate tool in predicting the depth of local tumour invasion and needs a place in the preoperative screening programme in patients with a rectal tumour, as well as in the postoperative follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)     

结肠癌前病变的临床研究──271例结肠腺瘤分析

对我院１９８７～１９９６年经结肠镜检出的２７１例结肠腺瘤进行了分析。提示以远侧结肠、大小＜１ｃｍ、表面光滑者及管状腺瘤多见。特别讨论了与癌的关系，证实了其是一种癌前病变。本组癌变平均年龄为５３．７岁，较腺瘤平均检出年龄长１０年。腺瘤恶变多见于绒毛状腺瘤，尤＞２ｃｍ，广基无蒂及外形呈颗粒菜花状者。恶变多发于直肠及乙状结肠。腺癌患者多表现为便血，处理以内镜下治疗为宜。     

Oncological outcomes of transanal local excision for high risk T(1) rectal cancers

AIM:To evaluate the oncological outcomes of transanal local excision and the need for immediate conventional reoperation in the treatment of patients with high risk T1 rectal cancers.METHODS:Twenty five high risk T1 rectal cancers treated by transanal local excision at the Guangdong General Hospital were analyzed retrospectively.Twelve patients received transanal local excision and 13 patients underwent subsequent immediate surgical rescue after transanal local excision within 4 wk.Differences in the local recurrence rates and 5-year overall survival rates between the two groups were analyzed.The prognostic value of immediate conventional reoperation for high risk T1 rectal cancers was also evaluated.RESULTS:The median follow-up period was 62 mo.The local recurrence rates after transanal local excisionfor high risk T1 rectal cancer were 50%.By immediate conventional reoperation,the local recurrence rates were significantly reduced to 7.7%.The difference between these two groups was statistically significant(P = 0.030).Kaplan-Meier survival analysis showed a trend for decreased 5-year overall survival rates for patients treated by transanal local excision compared with immediate conventional reoperation(63%vs 89%).CONCLUSION:Transanal local excision cannot be considered sufficient treatment for patients with high risk T1 rectal cancers.Immediate conventional reoperation should be performed if the pathology of the local excision is high risk.     

壶腹部肿瘤局部切除的临床与病理探讨

目的：探讨局部切除治疗壶腹部肿瘤的疗效。方法：对本院1994年2月～2006年3月27例实施了局部切除术的壶腹部肿瘤患者进行分析。结果：手术均获得成功，最终病理诊断为16例绒毛状腺瘤，4例管状腺瘤，1例神经鞘瘤；术中冰冻对检查腺癌的敏感性和特异性分别为25％和100％．阳性预测值和阴性预测值分别为100％和84％；患者平均住院7.9天，术后7例（26％）出现并发症，无围手术期和住院期间死亡病例；良性肿瘤的5年、10年复发概率分别为8％，17％，恶性肿瘤的5年、10年复发概率分别为19％，59％。5例患者在随访期死亡，2例死于腺癌复发，3例死于其他疾病。恶性肿瘤的5年，10年总体生存率为49％，26％．结论：对于壶腹部良性肿瘤局部切除是首选的方式而对于壶腹部恶性肿瘤应采用Whipple手术，局部切除适合于难以耐受手术者。     

16例直肠腺瘤的CT影像分析

[目的]探讨直肠腺瘤的CT表现.[方法]对16例经病理证实的直肠腺瘤CT表现进行回顾性分析.[结果]16例腺瘤按病理类型分为绒毛状腺瘤,管状绒毛状腺瘤和管状腺瘤,其中8例恶变.CT征象如下:广基生长有8例,窄基带蒂生长的5例,环壁增厚的有4例;向腔内匍匐式或菜花状生长的有10例;占肠周径比率在1/3以下的9例;病灶与直肠壁相贴时留下通气的间隙7例,可作为直肠腺瘤的特征性表现.[结论]一般直肠腺瘤均具有典型的CT表现,术前明确的腺瘤的CT诊断对于手术方式有重要影响.     

低位直肠癌前切除术中吻合器的应用价值(附420例病例报告)

背景与目的：中同直肠癌的发病率逐年上升，如何提高患者的生存率及术中保肌是目前探讨的热点话题本研究旨在探讨直肠系膜全切除术（TME）及吻合器在低位直肠癌保肌手术中的作用、方法：回顾性分析邯郸市中心医院2000--2006年间420例低位直肠癌患者用吻合器行直肠癌前切除术的临床资料结果：全组手术进行顺利，无手术相关死亡，术后局部复发17例．占手术病例总数的4％。1年生存率为100％，5年生存率为63.1％。结论：低位直肠痛保肛手术中行TME及应用吻合器可明显降低局部复发率及提高患者生存率.