直肠绒毛状腺瘤手术方式的探讨  

Evaluation and rational selection o f surgical procedures for rectal villous adenomas

作　　者：林国乐[1] 依沙克.司马义 吴斌[1] 关竞红[1] 邱辉忠[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院基本外科,100730 [2]新疆哈密地区中心医院外二科

出　　处：《中华胃肠外科杂志》2003年第3期171-173,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨直肠绒毛状腺瘤手术方式的合理选择。方法对70例手术治疗的直肠绒毛状腺瘤病例进行回顾性研究及随访。经肛门括约肌径路切除(Mason术)29例,直肠前切除术(Dixon术)16例,经肛门局部切除(transanalexcision,TE)11例,经骶部切除(Kraske术)5例,其他手术9例。结果25例(35.7%)直肠绒毛状腺瘤已发生癌变。70例患者术后并发症发生率为15.7%,术后复发率为14.3%。Mason术后并发症发生率和复发率分别为6.9%和0。结论选择直肠绒毛状腺瘤的手术方式应综合考虑腺瘤的具体部位、大小以及术前活检的病理结果,对于腺瘤癌变的病例还应考虑肿瘤浸润肠壁的深度。Mason术是治疗直肠中下段绒毛状腺瘤的理想术式。Objective To investigate the rational selection of surgical procedures for rectal villous adenomas.Methods Seventy patients with rectal villou s adenomas were treated by different surgical procedures,including Masons operation in 29patients(41.4%),Dixons operation in 16(22.9%),transanal excision in 25(35.7%),and other procedures in 9.The clini cal data were analyzed retrospectiv ely.Results Canceration was found in 25of 70patients with villous adenomas(35.7%).The overall morbidity and recurrence rates after all opera tions were 15.7%and 14.3%respectiv ely,while the morbidity and recurrence rates were only 6.9%(2/29)and 0%after Masons operations.Conclusions The location and size of rectal villous adenoma,and p reoperative pathological result of biopsy should be considered comprehensively before selecting s urgical procedures.The depth of tum or infiltration should also be considered for canceration.Mason o peration is a safe and effective meth od for the treatment of villous adenomas located at middle and lower rectum.[

关 键 词：直肠绒毛状腺瘤 手术方式 术后 并发症 Mason术 经肛门括约肌径路切除术 直肠前切除术 经肛门局部切除术 

分 类 号：R735.37[医药卫生—肿瘤]