Touzios John, Ludwig Kirk A
Division of General Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Clin Colon Rectal Surg. 2008 Nov;21(4):291-9. doi: 10.1055/s-0028-1089945.
The treatment of rectal neoplasia, whether benign or malignant, challenges the surgeon. The challenge in treating rectal cancer is selecting the proper approach for the appropriate patient. In a small number of rectal cancer patients local excision may be the best approach. In an attempt to achieve two goals-cure of disease with a low rate of local failure and maintenance of function and quality of life-multiple approaches can be utilized. The key to obtaining a good outcome for any one patient is balancing the competing factors that impact on these goals. Any effective treatment aimed at controlling rectal cancer in the pelvis must take into account the disease in the bowel wall itself and the disease, or potential disease, in the mesorectum. The major downside of local excision techniques is the potential of leaving untreated disease in the mesorectum. Local management techniques avoid the potential morbidity, mortality, and functional consequences of a major abdominal radical resection and are thus quite effective in achieving the maintenance of function and quality of life goal. The issue for the transanal techniques is how they fare in achieving the first goal-cure of the cancer while keeping local recurrence rates to an absolute minimum. Without removing both the rectum and the mesorectum there is no completely accurate way to determine whether a rectal cancer has moved outside the bowel wall, so any decision on local management of a rectal neoplasm is a calculated risk. For benign neoplasia, the challenge is removing the lesion without having to resort to a major abdominal procedure.
直肠肿瘤（无论良性还是恶性）的治疗都给外科医生带来了挑战。治疗直肠癌的挑战在于为合适的患者选择恰当的治疗方法。在少数直肠癌患者中，局部切除可能是最佳方法。为了实现两个目标——以低局部复发率治愈疾病以及维持功能和生活质量，可以采用多种方法。对任何一位患者取得良好治疗效果的关键在于平衡影响这些目标的相互竞争的因素。任何旨在控制盆腔内直肠癌的有效治疗都必须考虑肠壁本身的疾病以及直肠系膜中的疾病或潜在疾病。局部切除技术的主要缺点是可能会遗漏直肠系膜中未治疗的疾病。局部治疗技术避免了大型腹部根治性切除带来的潜在发病率、死亡率和功能后果，因此在实现维持功能和生活质量这一目标方面相当有效。经肛门技术面临的问题是，在将局部复发率降至绝对最低的同时，它们在实现第一个目标（治愈癌症）方面的效果如何。如果不切除直肠和直肠系膜，就没有完全准确的方法来确定直肠癌是否已扩散到肠壁外，所以任何关于直肠肿瘤局部治疗的决定都是一种风险权衡。对于良性肿瘤，挑战在于无需进行大型腹部手术就能切除病变。
