经肛超声刀局部切除治疗直肠腺瘤恶变和早期直肠癌15例

目的探讨低侵袭经肛超声刀局部切除治疗直肠腺瘤恶变和早期直肠癌的疗效和优越性。方法对15例直肠腺瘤恶变和早期直肠癌患者经肛门行局部切除术，采用5mm超声刀将直肠肿瘤完整切除（黏膜下或肌浅层），手术创口在腔内连续缝合。结果15例直肠腺瘤恶变、早期直肠癌均完整切除，切缘及基底均阴性，手术时间30—180min，平均60min，术中出血0～30ml，平均10ml；手术并发症：暂时性排气失控2例，急性尿潴留1例。术后病理：绒毛状腺瘤伴高级别上皮内瘤变8例，混合性腺瘤恶变2例，黏膜内癌5例。15例随访4—48个月，平均18个月，肿瘤无原位复发。结论低侵袭经肛超声刀局部切除治疗直肠腺瘤恶变和早期直肠癌是一种安全有效的手术方法，且保肛，提高了患者的生存质量。

Minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA:a report of 15 cases

Objective To evaluate the curative effect and superiority of minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA.Method Local resection was clone in 15 patients with cancerate rectal adenoma or early rectal cancer,the tumours were excised intactly by 5 mm CUSA(submucosal or superficial muscularis),the incisions were closed by continuous suture in the lumen.Results All of the tumours were excised intactly,the incisal edges and funduses were all negative.The operation time was 30～180 min,average:60 min,the amount of bleeding during operation was 0～30 ml,average:10 ml.Complications:temporary fecal incontinence in 2 cases,acute urinary retention in 1 case.Pathology after operation:villous adenoma accompanied by high grade intra epithelial neoplasia in 8 cases,mixed adenoma in 2 cases,intra-mucosal carcinoma in 5 cases.15cases were followed up 4～48 months,averge 18 months,no tumour recur in original place.Conclusion Minimally invasive transanal surgery by CUSA is a safe and effective operation in the treatment of cancerate rectal adenoma and early rectal cancer.It can keep the anus and improve the quality of life.