结肠镜联合腹腔镜诊治直肠癌合并结直肠息肉的探讨(附25例报告)

目的探讨直肠癌合并结直肠息肉的发生情况及腹腔镜结肠镜对直肠癌合并结直肠息肉的处理方法。方法回顾分析2003年1月～2006年12月该院25例直肠癌合并结直肠息肉行腹腔镜结肠镜处理患者的临床资料。结果直肠癌患者结肠镜检查结直肠息肉的检出率为24.10%,显著高于同期结肠镜检查结直肠息肉检出率的12.19%(P<0.01)。直肠癌行腹腔镜直肠癌根治术。腹腔镜直肠癌根治术术前、术中行结肠镜息肉摘除16例;术前结肠镜下注射亚甲蓝标记或术中结肠镜引导,腹腔镜行直肠癌根治术的同时行含息肉的结肠部分切除5例;直肠癌合并升结肠息肉恶变行腹腔镜直肠癌根治术同时行右半结肠切除1例;息肉靠近直肠癌一并行直肠癌根治性切除3例。结直肠息肉切除率100%,未出现并发症。25例术后随访0.5年～4.0年,2例死于肿瘤转移,23例存活,无肿瘤或息肉复发。结论直肠癌患者合并结直肠息肉的发生率较高。腹腔镜直肠癌根治性切除术术前或术中有必要行结肠镜检查,同时根据息肉情况选择结肠镜息肉切除或腹腔镜下息肉切除。

Analysis in diagnosis and treatment of rectal carcinoma accompanied with colorectal polyps with laparoscope and colonoscopy(a report of 25 cases)

Objective] To investigate the incidence of rectal carcinoma accompanied with colorectal polyps and management of rectal carcinoma accompanied with colorectal polyps with laparoscope and colonoscopy.Methods] The clinical data of 25 cases of rectal carcinoma accompanied with colorectal polyps admitted in our hospital from Jan.2003 to Dec.2006 was analyzed retrospectively.These patients were treated with laparoscopy and colonoscopy.Results] The incidence of colorectal polyps was 24.10% among the patients with rectal carcinoma.It was significantly higher than the incidence of colorectal polyps(12.19%)among all the patients who received colonoscopy simultaneously(P <0.01).All the patients with rectal carcinoma received laparoscopic radical resection.Colorectal polyps were removed by colonoscopy before or during operation(16 cases);Colorectal polyps(including some colon tissue)were removed by laparoscope following colonoscopic light during operation,or following the label(methylene blue)which was injected into colon tissue near polyps by colonoscopy before the operation(5 cases);The patient with rectal carcinoma and ascending colon polyps(malignant)received laparoscopic radical rectal resection and right half colostomy(1 case);The patient received radical rectal resection including polyps,while the polyps were near the carcinoma(3 cases).The resection rate of colorectal polyps was 100% and no complication occurred.After follow up from 1/2 to 4 years after operation,2 cases died of tumor metastasis,20 cases survived with no recurrence.Conclusions] The incidence of colorectal polyps was high among the patients with rectal carcinoma.Colonoscopy should be performed in the patients with rectal carcinoma pre-operation or intra-operation.Colorectal polyps also should be removed by colonoscopy or laparoscope according to the polyp itself.