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我科自1993年1月至1907年12月共收治33例直肠中下段肿物患者,其中直肠类癌6例,早期直肠癌3例、直肠息肉23例、错构瘤样息肉1例,距肛缘8cm、以下21例,8~12cm12例,肿物最小直径0.5cm,最大3.5cm。全部行局部切除术,手术途径:经肛门局部切除24例,经括约肌局部切除4例,经内镜电灼切除5例。结果:经8个月至4年随访,无局部复发。其中1例中段直肠癌,经括约肌局部切除后1年8个月局部未复发,但发现肝转移,另1例直肠类癌经肛门局部切除术后半年,因贫血行钡灌肠发现回盲部癌,再次行右半结肠切除术。本文就局部切除术的适应证、3种手术途径的优缺点进行了讨论。认为直肠中下段肿物局部切除术是对良性肿物和早期癌的一种可行的手术方法,但对早期癌的诊断应有足够的依据,腔内超声可提示癌肿侵犯深度及肿瘤周围淋巴结有无转移,为局部切除提供可靠依据。早期癌的局部切除宜采用经肛门括约肌途径,优点是视野显露清楚,肿瘤及肿瘤周围组织切除彻底,切除可深达肠壁全层,并保留了肛门括约肌的功能。缺点是切开括约肌有局部感染的可能,本组4例中有1例感染,经引流、换药痊愈。经肛门切除优点是保存了完整的肛门功能,缺点是视野狭小,一旦出血,止血困难,并易切除不完全。我们认为早期癌的局部切除和较大的息肉的局部切除最佳途径为?
Our department from January 1993 to December 1907, a total of 33 cases of patients with rectal cancer, including 6 cases of rectal carcinoid, 3 cases of early rectal cancer, rectal polyps in 23 cases, hamartoma-like polyps in 1 case, from Anal margin 8cm, the following 21 cases, 8 ~ 12cm12 cases, the smallest tumor diameter 0.5cm, the largest 3.5cm. All the local excision, surgical approach: 24 cases by anal partial excision, 4 cases by partial excision of the sphincter, endoscopic resection in 5 cases. Results: There was no local recurrence after 8 months to 4 years of follow-up. One case of middle rectal cancer, the local excision of the sphincter 1 year and 8 months after the local non-recurrence, but found that liver metastases, the other 1 case of rectal carcinoid after anal partial resection six months, due to anemia, barium enema found ileocecal carcinoma Right colon resection again. This article discusses the indications of local excision, the advantages and disadvantages of the three surgical approaches were discussed. That the middle and lower rectal tumor local excision of benign tumors and early cancer is a viable surgical approach, but the early diagnosis of cancer should have sufficient basis, intracavitary ultrasound can prompt the depth of invasion of cancer and lymph nodes around the tumor There is no transfer, to provide a reliable basis for local excision. Local resection of early cancer should adopt the anal sphincter approach, the advantage is that the field of vision revealed clearly, tumor and tumor tissue around the radical resection can be deep to reach the full thickness of the intestinal wall, and retained the anal sphincter function. Drawback is the possibility of incision sphincter local infection, the group of 4 patients in 1 case of infection, drainage, dressing cure. The anal resection has the advantage of preserving the integrity of the anal function, the disadvantage is the narrow field of vision, bleeding, bleeding difficulties, and easy to resect incomplete. We believe that the best way to local excision of the early stage of cancer and large resection of the polyp?