经尾骶部入路局部切除术治疗早期直肠肿瘤

The treatment of early rectal tumors-transsacral local excision for sphincter-preserving surgery

目的 :总结早期直肠癌经尾骶入路的局部切除经验 ,分析治疗效果。 方法 :对 1993年 1月至 2 0 0 3年 6月采用经尾骶部入路手术切除直肠下段早期肿瘤的 30例患者随访 1～ 8年 ,并进行回顾性分析。 结果 :除 1例局部复发 ,2例肺部转移和 1例死亡外 ,其余患者恢复良好。无直肠或肛门狭窄、大便失禁等并发症。 2例发生直肠吻合口瘘 ,经治疗后痊愈。 结论 :该术式适合中低位早期直肠癌 ,手术创伤小 ,操作方便 ,但应注意术后定期复查。对部分分化较差、恶性程度高的肿瘤 ,术后应进行放、化疗 ,以提高治疗效果。

Objective: To observe results of 30 patients with early distal rectal tumors taken transsacral local excision, and discuss which neoplasms are suitable for this sphicter-preserving surgery. Methods: Transsacral approach has been used for early rectal tumors within 3 to 8 cm from anal verge. The coccyx is removed, the antersacral fascia and levator muscles are divided, than rectum wall is incised and tumor local excision is performed under direct exposure, at last the defect of rectum wall closed. Results: With in 1 to 8 years follow-up all patients recovered well except one local recurrence and one lung metastasis. There is no complication such as rectum or anal narrow and incontinence of feces. Anastomotic leaks occurred in 2 cases and were cured by nonoperative treatment. Conclusion:This approach has many merits such as little trauma and convenient operative in the treatment of early lower rectum cancers. Regular reexamines are needed. Postoperative radiation therapy, chemotherapy are recommended for some poorly differentiated tumor with bad biological manner to improve treatment results.