直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用  

Pull-through transection and anastomosis for low rectal lateral spreading villous adenoma

作　　者：傅传刚[1] 高显华[1] 王颢[1] 于志奇[1] 徐晓东[1] 王汉涛[1] 刘连杰[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《外科理论与实践》2012年第5期467-471,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：探讨直肠拖出式切除吻合术在低位直肠侧方生长型绒毛状腺瘤中的应用价值。方法：回顾性分析我院28例行直肠拖出式切除术（试验组）和35例行经肛门局部切除术（对照组）的低位直肠侧方生长型绒毛状腺瘤病人治疗。结果：63例术前诊断为直肠绒毛状腺瘤，均占肠腔1／2周以上。术后病理证实有29例（46．0％）已发生癌变，其中12例浸润黏膜下层。15例浸润肌层，2例浸润外膜层；其中2例伴肠系膜淋巴结转移。试验组术后有3例病人分别出现吻合口漏、腹壁切口感染和不完全性肠梗阻；对照组术后有1例出现直肠出血。两组均无围手术期死亡。术后平均随访（47．8±18．0）（6～82）个月。试验组无复发；对照组有20例（57．1％）复发，其中15例为反复多次复发。有2例反复复发后演变成浸润癌．继而行Miles术。另1例术后1年出现多发肺转移。术后6个月，试验组平均每天排便（4．4±2．2）（2－9）次，仅5例有轻度大便污裤；仅1例有轻度的勃起功能障碍。对照组无明显控便功能和性功能障碍。结论：直肠拖出式切除术治疗直肠低位侧方生长型绒毛状腺瘤复发率低，消除了癌变和部分癌变进展的风险，未出现严重的并发症．肛门控便功能和性功能也保存较好，是一种比较理想的术式，值得临床推广。Objective To evaluate the application of pull-through transection and anastomosis for low rectal lateral spreading villous adenoma. Methods Sixty-three patients with low rectal lateral spreading villous adenoma operated in our hospital were retrospectively studied. Among them, 28 patients underwent pull-through transection and anastomosis （the pull-through group） and 35 patients underwent transanal local excision（the transanal group）. Results All of the 63 patients were preoperatively diagnosed as rectal villous adenoma, and occupied more than 1/2 cycle of the intestinal lumen. Twenty-nine （46.0%） were re-categorized as invasive cancer by postoperative pathological examination （invaded submucosa in 12, invaded muscularis propria in 15 and invaded the whole rectal wall in 2）. Two patients had positive mesenteric lymph nodes. Postoperative complications occurred in 3 patients from the pull-through group （anastomotic leakage, wound infection and incomplete intestinal obstruction） and 1 patient from the transanal group （rectal bleeding）. No perioperative mortality occurred in both groups. The mean follow-up period was （47.8±18.0）（6-82） months. There were 20 recurrences （57.1%）, all from the transanal group. Fifteen of them had multiple recurrences. Two cases had transformed into invasive rectal cancer after multiple recurrences, and underwent Miles procedure eventually. There was still one patient who had multiple lung metastases one year after the last operation. The fecal continence and sexual function were evaluated at 6 months after operation. In the pull-through group, the daily fecal frequency is （4.4±2.2） （2-9） times, with slight fecal incontinence in 5 cases and slight erectile dysfunction in one case. No fecal or sexual impairment occurred in the transanal group. Conclusions The pull-through transection and anastomosis is warranted for low rectal lateral spreading villous adenoma. It is associated with lower recurrence rate, reduced risk of malignancy, less compl

关 键 词：直肠拖出式切除 直肠绒毛状腺瘤 侧方生长型肿瘤 

分 类 号：R735.37[医药卫生—肿瘤]