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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 investigate the application of partial rectal resection in the treatment of rectal benign and malignant tumors. Methods: The clinical data of 44 patients with benign and malignant rectal neoplasms in our hospital from January 1998 to December 2005 were analyzed retrospectively. The sacrococcygeal approach partial excision of 24 cases; 17 cases of partial removal of the anus. For 3 patients with multiple rectal lesions, one case of multiple focal lesion was enlarged by transabdominal enlargement, and 1 case was treated by sacrococcygeal approach and partial anal resection. At the same time, 1 case was treated by abdominal and transanal resection. Results: Postoperative pathological diagnosis showed 17 cases of rectal tubular villous adenoma with epithelial dysplasia (1 case of multiple adenoma), 11 cases of rectal tubular villous adenoma, 9 cases of rectal carcinoid, 1 rectal adenocarcinoma of rectum 1 case of rectal malignant melanoma, 1 case of rectal stromal tumor, 4 cases of proliferative polyps (2 cases of multiple polyps). The whole group of 44 patients with incision healed. No anal incontinence occurred. Of the 25 patients who underwent resection of the sacrococcygeal tract, 2 were complicated with fecal fistula (2/25, 8%) and were cured in January. Two patients with rectal adenoma resected by the sacrococcygeal approach showed recurrence (2/25, 8%) 1 year after surgery, one patient underwent additional Parks procedure, and one patient underwent rectal enlargement and resection. Conclusion: Local resection of the rectum is widely used in the surgical treatment of benign and malignant tumors of the rectum. It is one of the best choices for preserving anus surgery.