Frazee R C, Patel R, Belew M, Roberts J W, Hendricks J C
Scott & White Clinic, Temple, Texas, USA.
Am Surg. 1995 Aug;61(8):714-7.
Twenty-two men and 16 women with a mean age of 67 years were treated for rectal carcinoma by transanal excision. Patients presented with rectal bleeding (63%), change in bowel habits (11%), rectal pain (4%), or were asymptomatic and discovered on screening proctosigmoidoscopy (22%). The tumors were located from the anal verge to 8 cm proximally and ranged in size from 1 to 4 cm. Pathologic findings included adenocarcinoma (92%), squamous cell carcinoma (4%), and cloacogenic carcinoma (4%). Postoperative hospitalization averaged two days (0 to 29 days). One patient died of a perioperative myocardial infarction for an operative mortality of 3 per cent. Morbidity was 7 per cent and included urinary retention and pneumonia. Postoperative radiation therapy was administered to 11 patients with either undifferentiated tumors or invasion into the muscularis propria. Follow-up in these 38 patients averaged 30 months. One patient died of metastatic carcinoma, and two patients developed local recurrence that was treated successfully by a low anterior resection or abdominoperineal resection. Transanal excision of rectal carcinoma can be performed in properly selected patients with good overall survival and local control.
22名男性和16名女性平均年龄67岁，接受了经肛门切除术治疗直肠癌。患者表现为直肠出血（63%）、排便习惯改变（11%）、直肠疼痛（4%），或无症状，在筛查乙状结肠镜检查时发现（22%）。肿瘤位于距肛缘至近端8厘米处，大小从1至4厘米不等。病理结果包括腺癌（92%）、鳞状细胞癌（4%）和泄殖腔源癌（4%）。术后住院时间平均为两天（0至29天）。1例患者死于围手术期心肌梗死，手术死亡率为3%。发病率为7%，包括尿潴留和肺炎。11例肿瘤未分化或侵犯固有肌层的患者接受了术后放疗。这38例患者的随访时间平均为30个月。1例患者死于转移性癌，2例患者出现局部复发，通过低位前切除术或腹会阴联合切除术成功治疗。经肛门切除直肠癌可在适当选择的患者中进行，总体生存率和局部控制良好。
