直肠局部切除术治疗直肠良恶性肿瘤(附44例报告)

Local excision of rectal tumors

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。

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.