直肠中下段腺瘤经直肠前括约肌径路手术方式探讨

Evaluation of the Anterior Transsphincteric Removal of Rectal Adenoma on the Mid and Low Rectum

目的探讨经直肠前括约肌径路治疗直肠中下段腺瘤的适应证和价值。方法回顾性分析5年内我院收治的经直肠前括约肌径路手术切除直肠中下段腺瘤16例患者的临床资料,其中管状腺瘤3例,绒毛状腺瘤9例,绒毛状腺瘤癌变4例。肿瘤下缘距肛缘5～8 cm,平均7 cm;瘤体直径2～4 cm。结果16例肿瘤均获完整切除,切缘均阴性;其中,行直肠部分切除术14例,直肠节段切除术2例。患者均保留了排便、排尿及性功能,无术后并发症。全组平均随访36个月,无肿瘤局部复发。结论经直肠前括约肌径路局部切除中低位直肠腺瘤具有损伤小、显露良好、操作简便及病灶清除彻底的优点,值得临床推广运用。

Objective To explore the value and indication of the anterior transsphincteric operation for treating rectal adenoma on the mid and low rectum. Methods The clinical data of 16 cases with rectal adenoma operated by anterior transsphincteric approach from February 2004 to August 2008 were analyzed retrospectively. These included 13 villous adenoma malignant （four cases had changed） and 3 canalicular adenoma. The distance between the anal verge and the lower margin of the tumor was 5-- 8 cm（averaged 7 cm）. The diameter of tumor was 2--4 cm. Results The rectal adenoma was completely removed with negative resection margins in all the 16 patients. Of the 16 patients, 14 underwent partial rectectomy and 2 segmental rectectomy. Fecal continences, urinary function and sexual function were preserved successfully in all the patients. No complications developed. At a median followup of 36 months, no patients had recurrences. Conclusion Anterior transsphincteric operation for resection of adenoma on middle and low rectum has the advantages of little injury, good exposure in operation, easy manipulation and thorough clearence of the focus.