28例低位直肠绒毛状腺瘤癌变局部切除治疗经验

Local Excision of Low Rectal Villous Adenoma with Malignant Change

目的:探讨合理选择治疗低位直肠绒毛状腺瘤癌变的手术方式。方法:回顾性分析我院28例经局部切除治疗的低位直肠绒毛状腺瘤癌变的临床资料,并加以讨论。结果:经肛局部切除(transanalexcision,TE术)20例,经骶局部切除(Kraske术)8例。术后病理高、中分化腺癌27例,低分化腺癌1例;肿瘤浸润粘膜层13例,浸润粘膜下层12例,浸润肌层3例。术后复发4例,转移2例,5年生存率78.6%(22/28)。结论:直肠绒毛状腺瘤癌变恶性程度低,对于病变位于低位直肠的患者,只要符合适应证,则局部切除术既可以达到根治术的疗效,又能保留正常排便功能,提高患者生存质量。

Objective: To explore rational surgical treatment for low rectal villous adenoma with canceration. Methods: Twenty-eight cases of distal rectal villous adenoma with canceration undergoing local excision were analyzed retrospectively. Results: Twenty patients underwent transanal excision and 8 with Kraske resection. Twenty-seven showed high or middle differentiation and only 1 showed low differentiation in pathology after operation; tumors confined to the mucosa and submucosa were 13 and 12 respectively, only 3 lesions infiltrated to the muscularis. 4 suffered recurrence and 2 metastasis; the 5-year survival rate was 78.6% (22/28). Conclusions: Most rectal villous adenomas with canceration were less invasive;for the patients adapted to the indication, local excision could not only cure the tumor, but also promoted the living standard.