经直肠前括约肌径路治疗直肠绒毛状腺瘤的方法评价

Evaluation of the anterior transsphincteric removal of rectal villous adenoma

目的探讨经直肠前括约肌径路治疗直肠绒毛状腺瘤的安全性和价值。方法回顾性分析6年半内收治的经直肠前括约肌径路手术切除直肠绒毛状腺瘤17例患者的临床资料。其中绒毛状腺瘤癌变6例。肿瘤下缘距肛缘5～8cm,平均7cm,瘤体直径2～5cm。结果17例肿瘤均获完整切除,切缘均阴性。患者均保留了排便、排尿及性功能,无术后并发症。6例恶变者术后病理分期:pTisN0M0期3例,pT1N0M0期2例,pT2N0M0期1例。全组平均随访46个月,无肿瘤复发。结论经直肠前括约肌径路是治疗直肠绒毛状腺瘤及其早期癌变的一种安全可靠手术方式,尤其适用于位于直肠中段较大的病变。

Objective To evaluate the value and safety of the anterior transsphincteric operation for treating rectal villous adenoma. Methods The clinical data of 17 cases with rectal villous adenoma, including 6 cases with malignant change, operated by anterior transsphincteric approach at Changzheng hospital, from February 2000 to August 2006, were analyzed retrospectively. The distance between the anal verge and the lower margin of the tumor was 5 - 8 cm （ average 7 cm ）. The tumors were 2 - 5 cm in diamater. Results The rectal villous adenoma was completely removed with negative resection margins in all the 17 patients. Fecal continence, urinary function and sexual function were preserved successfully in all the patients. No postoperative complications developed. The postoperative pathological stage of rectal villous adenoma with malignant change was pTis＋ N0 M0 in 3 cases, pT1 N0 M0 in 2, and pT2 N0 M0 in 1. At a median follow-up of 46 months, no patients had recurrence. Conclusions Anterior transsphincteric approach is useful and safe for operation of rectal villous adenomas and those with early mmalignant change. It is particularly valuable for large midrectal villous adenoma.