Dupont-Lampert V, Herzog U, Schuppisser J P, Tondelli P
Service de Chirurgie, Kantonspital Basel, Bale, Suisse.
Ann Chir. 1992;46(4):341-5.
Forty-two mobile tumours on digital rectal examination were excised by posterior rectotomy: via a transsphincteric approach in 16 cases and via a pararectal suprasphincteric approach in 26 cases; 3 primary protective colostomies were performed. Nineteen tubulovillous adenomas and 23 carcinomas were excised. The excision included the entire thickness of the rectal wall in the form of resection-anastomosis (n = 10) or a disk resection (n = 32). This series consisted of 27 males and 15 females between the ages of 42 and 92 years (mean = 70 years). The definitive histology revealed 12 T1 tumours, 7 T2 tumours and 3 T3 tumours. There were two postoperative deaths. The remaining patients have a mean postoperative follow-up of 45 months. 2/16 (12.5%) local recurrences occurred in the group of tubulovillous adenomas and 2 local recurrences with distant metastases were observed in the carcinoma group, while 3 patients only developed distant metastases. The cancer-related mortality was 5/21 (23.89%). Disturbances of continence persisted in 6/29 surviving patients, 4 patients complained of urgent defecation, 1 of uncontrolled passage of gas and a single patient had persistent incontinence of liquid stools. Posterior rectotomy allows excision of extensive tubulovillous adenomas and local recurrences are less frequent than after transanal excision and are similar to the results obtained with transabdominal rectal resections. The operative mortality was lower than that of laparotomy. Posterior rectotomy allows adequate resection of localised carcinomas (T1) with no lymph node involvement. The statistical frequency of lymph node metastases in stage T2 and T3 tumours only justifies the use of this technique when the patient refuse colostomy, has an excessively high risk to undergo laparotomy or when the operation is purely designed to be palliative. The disturbances of continence observed were minor and only slightly disabling.
通过直肠后切除术切除了42例指诊可及的活动肿瘤：16例经括约肌间入路，26例经直肠旁括约肌上入路；实施了3例一期保护性结肠造口术。切除了19例管状绒毛状腺瘤和23例癌。切除范围包括以切除吻合术（n = 10）或盘状切除（n = 32）形式的直肠壁全层。该系列包括27例男性和15例女性，年龄在42至92岁之间（平均 = 70岁）。最终组织学检查显示12例T1肿瘤、7例T2肿瘤和3例T3肿瘤。有2例术后死亡。其余患者术后平均随访45个月。管状绒毛状腺瘤组发生2/16（12.5%）局部复发，癌组观察到2例局部复发伴远处转移，同时有3例患者仅发生远处转移。癌症相关死亡率为5/21（23.89%）。29例存活患者中有6例存在控便障碍，4例患者主诉排便急迫，1例患者存在气体失控排出，1例患者持续存在液体粪便失禁。直肠后切除术可切除广泛的管状绒毛状腺瘤，局部复发率低于经肛门切除术后，且与经腹直肠切除术的结果相似。手术死亡率低于开腹手术。直肠后切除术可对无淋巴结受累的局限性癌（T1）进行充分切除。T2和T3期肿瘤中淋巴结转移的统计频率仅在患者拒绝结肠造口术、接受开腹手术风险过高或手术纯粹为姑息性目的时才证明使用该技术是合理的。观察到的控便障碍较轻，仅造成轻微残疾。
