大肠癌合并大肠息肉的外科治疗体会

Experience on the Surgical Treatment of Large Intestinal Carcinoma Associated with Large Intestinal Polyps

为探讨大肠癌合并大肠息肉的手术处理方法及疗效，回顾分析56例大肠癌合并大肠息肉病例的诊治资料。结果显示，2004年3月至2009年7月收治的255例大肠癌患者中共发现并存大肠息肉者56例，其中45例行术前息肉摘除手术，7例行术中结肠息肉切除，4例在术后进行结肠息肉摘除。全组无手术并发症发生，息肉切除部位无残留、恶变或癌种植转移。结果表明，术前应用内镜切除是治疗大肠癌合并大肠息肉的主要手段；不宜内镜切除者，尽量采用扩大切除术；远离大肠癌常规切除范围、较分散的息肉和不宜扩大切除的患者，可在内镜定位下行局部切除，如为恶性息肉则行结肠次全或全切除。双镜联合可提高大肠息肉的诊治水平。

In order to investigate the operative decision for large intestinal carcinoma associated with large intestinal polyps,and its therapeutic effect,author retrospectively analysed the diagnosis ＆ treatment data from 56 patients with this diseases. As results,among the 255 patients with large intestinal carcinoma ad- mitted from March 2004 yr. to July 2009 yr. 56 patients were associated with large intestinal polyps, in- cluded 45 subjected to preoperative removal of polyps,7 to intraoperative resection of large intestinal polyps,and 4 to postoperative removal of large intestinal polyps ; In the 56 patients no operative complication, no residual tissue, carcinomatous conversion or metastasis of a cancer at resected sites of polyps were found. Results show that preoperative endoscopic resection is of main measures for treating the concurrent disease; for the patients unfit for endoscopic resection, as possible as using extended resection is done; for the patients unfit to extended resection,and the more interspersed polys more far from routine resection range of large intestinal carcinoma ,performing local resection under endoscope could be done;if malignant polyps, must be pancolectomy or sub-resection of colon;using double-endoscope can enhance the level of diagnosis ＆ treatment of large intestinal polyps.