经骶尾局部切除治疗直肠中下段肿瘤

目的探讨经骶尾局部扩大切除术在中下段直肠肿瘤治疗中的应用效果。方法回顾性分析1994年9月至2005年9月间在江苏省肿瘤医院普通外科接受经骶尾局部扩大切除术治疗的133例中下段直肠肿瘤患者的临床资料。结果全组无手术死亡者，6例（4．5％）并发粪瘘。全组患者肿瘤切缘与基底均阴性。术后诊断为腺瘤28例，增生性息肉3例．类癌8例，间质瘤1例，腺瘤伴黏膜内癌变29例，黏膜下癌64例。64例T1期腺癌患者中位随访期76个月，5年累计局部复发率2．0％。5年总生存率100％。其余患者均无局部复发。结论经骶尾局部扩大切除术简便、安全，适合中低位直肠良性肿瘤的治疗与低位T1期直肠癌的选择性保肛手术治疗。

Transsacral local wide resection for mid-lower rectal tumors

Objective To evaluate the efficacy of transsacral local wide resection for mid lower rectal tumors. Methods Clinical data of 133 patients undergone transsacral local wide resection for mid-lower rectal tumors between September 1994 and September 2005 were analyzed retrospectively. Results No patient died during operation. Fecal fistula occurred in 6 (4.5%) patients. Negative resection margin was proved histologically in all the patients. Postoperative diagnosis was adenoma in 28 patients, hyperplastic polyp in 3 patients, carcinoid in 8 patients, gastrointestinal stromal tumor in 1 patient, adenoma with intra-mucosal carcinogenosis in 29 patients and adenocareinoma invading into submucosa in 64 patients. Median follow-up was 76 months in 64 patients with T1 adenocarcinoma, whose 5-year cumulative local recurrence and overall survival were 2.0% and 100% respectively. No local recurrence was observed in other patients. Conclusion Transsacral local wide resection is simple and safe for mid-lower rectal tumors, which is an appropriate procedure for mid-lower rectal benign tumor and can serve as a sphincter-saving operation for selected T1 lower rectal carcinoma.