直肠局部切除术治疗直肠良恶性肿瘤(附44例报告)

目的:探讨直肠局部切除术在直肠良恶性肿瘤治疗中的应用。方法:回顾性分析1998年1月至2005年12月收治的44例中、低位直肠良恶性肿瘤的临床资料。经骶尾后入路局部切除24例;经肛局部切除17例。对于3例直肠多发性病灶的患者,经腹局部扩大切除多发性病灶1例,同时经骶尾后入路和经肛局部切除1例,同时经腹和经肛局部切除1例。结果:术后病理学诊断显示直肠管状绒毛状腺瘤伴上皮异型增生17例(其中多发性腺瘤1例);直肠管状绒毛状腺瘤癌变11例;直肠类癌9例;直肠早期腺癌1例;直肠恶性黑色素瘤1例;直肠间质瘤1例;增生性息肉4例(其中多发性息肉2例)。全组44例患者切口均I期愈合。无肛门失禁发生。在25例经骶尾后入路局部切除的患者中,2例并发粪瘘(2/25,8%),均于术后1月痊愈。经骶尾后入路局部切除的2例直肠腺瘤患者,术后1年出现复发(2/25,8%),1例追加Parks术,1例再次经肛局部扩大切除。结论:直肠局部切除术在直肠良恶性肿瘤的外科治疗中应用广泛,是保留肛门功能手术的最佳选择之一。

Local excision of rectal tumors

Objective:To study the application of local resection in the treatment of various tumors in the rectum. Methods:The clinical data of 44 patients with mid-lower rectal tumors from January 1998 to December 2005 were analyzed retrospectively. Twenty-four patients underwent posterior approach transsacral local resection, while 17 patients received transanal procedure. For 3 patients with multiple rectal lesions, 1 underwent a trans-abdominal wider local resection, 1 underwent transsacral and a transanal excision at the same time, and 1 trans-abdominal and transanal procedure at the same time. Results:Postoperative pathology showed that, of the 44 patients, 17 were tubulo-villous adenoma with epithelial displasia, including 1 multiple adenomas; 11 canceration of tubulo-villous adenoma; 9 carcinoid tumor; 1 early stage carcinoma; 1 rectal melanoma; 1 rectal GIST and 4 polyps. The wounds healed well in all of the patients and no anal dysfunction occurred. Of the 25 cases who underwent posterior transsacral procedure, fecal fistula occurred in 2 patients, which healed one month after the procedures. Recurrence occurred in 2 patients of adenoma who underwent transsacral excision one year after the procedure. These 2 patients were re-operated with a Parks' procedure and a transanal resection respectively. Conclusion:Local rectal resection is widely applied in the surgical treatment of various benign and malignant tumors in the rectum. It is one of the best choices of the anus-preserving procedures.