Zhou Xin, Huang Xin-En, Zhang Tong, Shang Jun-Qing, Guan Xin, Zhong Jian, Feng Bo, Sun Yue, Zhou Jian-Nong
Colorectal Cancer Center, Jiangsu Cancer Hospital and Research Institute, Nanjing, China.
Asian Pac J Cancer Prev. 2011;12(4):1045-8.
To investigate the feasibility of extended full-thickness transanal local excision for rectal cancers invading anorectal junction.
Four patients with small (size ≤3cm) unfixed rectal cancer, which extended into the upper anal canal, were submitted to transanal local excision with a dissection plane extended to the striated muscle layer around the upper anal canal, so that a portion of striated muscle beneath or around the tumor was excised en bloc with the anorectal wall. The defect in the anorectal wall was laid open to granulate and epithelize.
The mean operative time was 28±6 min, with no related mortality. Postoperative pathological examination confirmed clear resection and revealed 1, T2, 2, T1, and 1 Tis carcinomas. The median follow-up was 3.2 months (range, 1.5-13.0 months). Minor soiling with flatus incontinence was common during the first postoperative month. Two patients with a follow-up longer than 3 months had perfect anal continence. No local recurrence was observed.
Extended full-thickness transanal local excision for rectal tumors lying at the anorectal junction is safe and simple. Patients with partial excision of striated muscle around the upper anal canal may still enjoy good anal continence. Further studies on extended full-thickness transanal excision are worthwhile.
探讨扩大全层经肛门局部切除侵犯肛管直肠交界部直肠癌的可行性。
4例小（直径≤3cm）的未固定直肠癌累及肛管上段患者，接受经肛门局部切除，手术分离平面延伸至肛管上段周围的横纹肌层，使肿瘤下方或周围的部分横纹肌与肛管直肠壁整块切除。肛管直肠壁的缺损敞开，待其肉芽组织生长和上皮化。
平均手术时间为28±6分钟，无相关死亡病例。术后病理检查证实切除彻底，并显示1例T2、2例T1和1例Tis癌。中位随访时间为３.2个月（范围1.5-13.0个月）。术后第一个月内，轻微的排气失禁导致的便污很常见。2例随访时间超过3个月的患者肛门控便功能良好。未观察到局部复发。
对位于肛管直肠交界部的直肠肿瘤进行扩大全层经肛门局部切除是安全且简单的。肛管上段周围横纹肌部分切除的患者仍可保持良好的肛门控便功能。扩大全层经肛门切除值得进一步研究。
