直肠类癌手术方式的探讨

目的探讨直肠类癌手术方式的合理选择。方法对我院1982年4月-2008年12月间手术治疗的51例直肠类癌病例进行回顾性研究及随访。结肠镜下肿瘤电切术3例，经肛门局部切除术13例，经肛门括约肌的直肠外科手术（Mason术）7例，经肛门内镜微创手术（TEM）18例，直肠前切除术（Dixon术）2例，经腹直肠切除经肛门结肠肛管吻合术（Parks术）2例，腹会阴联合直肠肿瘤切除术（Miles术）4例，其他手术2例。结果术后病理确诊直肠类癌残灶显慢性炎11例，直肠类癌局限于粘膜下层以内者（pT0或pT1期）28例，直肠恶性类癌（神经内分泌癌）12例（23．5％）。全组51例患者手术并发症的发生率为3．9％。12例直肠恶性类癌中1例Miles术后发生肝转移，2例经肛门切除术后复发。本组中7例Mason术和18例TEM术后均未发生并发症或肿瘤局部复发。结论选择直肠类癌的手术方式应综合考虑类癌的具体部位、大小以及术前活检的病理结果，对于疑诊恶性的病例还应考虑肿瘤浸润肠壁的深度。Mason术和TEM为适合局部切除的直肠类癌患者提供了理想的术式选择。

Evaluation and rational selection of surgical procedures for rectal carcinoid tumors

To investigate the rational selection of surgical procedures for rectal carcinoid tumors. Methods The clinical data of 51 patients with rectal carcinoid tumor treated by different surgical procedures in our hospital between April 1982 and December 2008 were analyzed retrospectively. Procedures included endoscopic polypectomy using snare diathermy （ n = 3 ）, transanal local excision （ n = 13 ）,posterior trans - sphincteric approach （ Mason＇s operation） （ n = 7 ）, transanal endoscopic microsurgery （TEM） （ n = 18 ）, Dixon＇s operation （ n = 2 ）, Park＇s operation （ n = 2）, abdominoperineal resection （ Miles operation） （n = 4）, and other procedures （ n = 2）. Results The postoperative pathological di- agnosis included chronic inflammatory rectal lesion after endoscopic polypectomy in 11 patients, rectal carcinoid tumor with stage pT0 or pT1 in 28 patients, and advanced rectal carcinoid tumor （ neuroendo- crine carcinoma） in 12 patients （23.5%）. The rate of complications of all operations was 3.9%. One of 12 patients with advanced rectal carcinoid tumor developed liver metastasis after Miles operation, and two developed postoperative tumor recurrence after transanal local excision. None of 7 patients after Mason＇s operation and 18 patients after TEM developed postoperative complication and local tumor recurrence. Conclusion The location, size and result of preoperative biopsy of rectal carcinoid tumors should be considered comprehensively before selecting surgical procedures. The depth of invasion should be also considered when selecting treatment for those patients with suspect advanced rectal carcinoid tumor. Mason＇s operation and TEM provide ideal alternative for patients with rectal carcinoid tumor amenable to treatment using local therapy.