经直肠前括约肌途径直肠外科手术  

Anterior transsphincteric approach for the surgery of the rectum

作　　者：何远翔[1] 王为民[1] 查玮[1] 王强[1] 

机构地区：[1]第二军医大学长征医院普通外科,上海200003

出　　处：《中国实用外科杂志》2007年第9期730-732,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨经直肠前括约肌途径手术的安全性和价值。方法对1999年12月至2006年6月第二军医大学长征医院采用经直肠前括约肌途径手术切除直肠病变行的34例临床资料进行总结。其中早期直肠癌13例,绒毛状腺瘤癌变6例,绒毛状腺瘤10例,管状腺瘤3例,类癌2例。肿瘤下缘距肛缘5-10cm,平均7.5cm,瘤体直径1-5cm。结果34例直肠肿瘤均获完整切除,切缘均阴性。病人均成功地保留了排便、排尿及性功能,无术后并发症。直肠癌及直肠绒毛状腺瘤癌变术后病理分期：pTisN0M0期11例,pT1N0M0期5例,pT2N0M0期3例。2例直肠类癌限于黏膜下层。全组平均随访45个月,无肿瘤复发。结论经直肠前括约肌途径治疗直肠病变是安全可靠的,具有显露良好、切除完整的优势,适用于可行局部手术治疗的中下段直肠良、恶性疾病的治疗。Objective To evaluate the value and safety of anterior transsphincteric approach for treating rectal tumor. Methods From December 1999 to June 2006 the anterior transsphincteric operation was performed on 34 patients with diseases of rectum. These included early rectal carcinoma 13,16 villous adenoma malignant change 6,3 canalicular adenoma and 2 carcinoid. The distance between the anal verge and the lower margin of the tumor was 5 - 10 cm（ averaged 7.5 cm）. The diameter of tumor was 1 - 5 cm. Results The rectal tumor was completely removed with negative resection margins in all the 34 patients. Fecal continences, urinary function and sexual function were preserved successfully in all patients. No complications developed. The postoperative pathological stages of rectal carcinoma and villous adenoma canceration were pTisNOM0 in 11 patients, pT1NOM0 in 5, pT2NOM0 in 3, Two cases of carcinoid confined to the submucosa. At a median follow-up of 45 months, no patients had recurrences. Conclusion Anterior transsphincteric approach was useful and safe for rectal diseases. It is satisfactory because of good exposure and thorough excision, which is suitable for those lesions that could be locally resected on the mid and low rectum.

关 键 词：直肠肿瘤 经括约肌途径 保肛手术 

分 类 号：R6[医药卫生—外科学]