Fry D E, Amin M, Harbrecht P J
Ann Surg. 1979 Apr;189(4):488-92.
The records of 13 patients with symptomatic rectal obstruction secondary to prostatic carcinoma have been critically reviewed to provide criteria for identifying this atypical presentation. The site of obstruction varied from the anal verge to 17 cm by sigmoidoscopy. Significant clinical findings were ureteral obstruction on excretory urography in 12 of the patients, elevated acid phosphatase in eight, intact mucosa over the obstructing mass in seven and osteoblastic bone metastasis in six. Primary diagnosis was generally established by comparing histopathologically the prostate and the obstructing lesion. Colostomy was necessary in nine cases. In three patients colostomy was obviated in partially obstructing lesions by intravenous diethylstilbestrol diphosphate therapy. One patient had an inappropriate low anterior resection. Rectal obstruction is most commonly due to primary adenocarcinoma. Occasionally the obstruction is secondary to prostatic carcinoma masquerading as an intrinsic rectal cancer. Identification of the true nature of the illness is essential for proper treatment.
对13例因前列腺癌继发症状性直肠梗阻患者的记录进行了严格审查，以提供识别这种非典型表现的标准。通过乙状结肠镜检查，梗阻部位从肛门边缘至17厘米不等。显著的临床发现包括：12例患者排泄性尿路造影显示输尿管梗阻；8例酸性磷酸酶升高；7例梗阻肿块表面黏膜完整；6例有成骨性骨转移。原发性诊断通常通过对前列腺和梗阻性病变进行组织病理学比较来确立。9例患者需要进行结肠造口术。3例部分梗阻性病变患者通过静脉注射二磷酸己烯雌酚治疗避免了结肠造口术。1例患者进行了不恰当的低位前切除术。直肠梗阻最常见的原因是原发性腺癌。偶尔，梗阻是由伪装成原发性直肠癌的前列腺癌继发引起的。明确疾病的真实性质对于正确治疗至关重要。
