经肛门括约肌入路的直肠外科手术

Transsphincteric Surgery of the Rectum

目的探讨经肛门括约肌路径的手术在直肠外科中的应用。方法回顾性分析1990年8月～2009年12月170例中下段直肠疾病患者施行Mason手术的经验。结果170例中直肠绒毛状腺瘤90例,早期直肠癌53例,进展期直肠癌10例。以直肠类癌为主的黏膜下结节26例。直肠肿瘤中行直肠部分切除术136例,直肠节段切除术10例。直肠阴道/尿道瘘21例,其中一次修补成功者17例(81%)。术后伤口积液感染7例(4.1%),直肠-皮肤瘘6例(3.5%)。早期直肠癌的肿瘤局部复发率为3.9%(2/51)。其中存活超过5年者45例,占88.2%(45/51)。170例术后未发生肛门失禁。结论Mason手术具有手术进路直达,术野表浅和显露良好的特点,适用于可行局部手术治疗的中下段直肠良恶性疾病。

ObjectiveTo explore the role of transsphincteric operation （Mason operation）in the rectal surgery.MethodsRetrospective study was used to analyze the experience of Mason operation for 170 patients with mid and low rectal disease between Aug 1990 to Dec 2009. ResultsThere were villous adenoma in 90 cases, early rectal cancer in 53 cases and advanced rectal cancer in 10 cases. Submucosal tumor included carcinoid was in 26 cases.Of the 146 patients with rectal tumor, 136 underwent partial rectectomy, 10 underwent segmental rectectomy.There were rectovaginal fistula or rectourethral fistula in 21 cases and success of repair was in 17 cases （81%）. Seven patients（4.1%） developed wound infection. Six patients （3.5%）were complicated with recto-cutaneous fistula. Two patients（3.9%） had local recurrence and 88.2% （45/51） patients were survival above five years after operation in group of early rectal cancer.No patient suffered from incontinence of stool when he was dischargeed from hospital.ConclusionMason operation is satisfactory with good exposure and simple access to the rectum,which was suitable for those lesions that could be locally resected on mid and low rectum.