Agachan F, Iroatulam A, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
JSLS. 1998 Jul-Sep;2(3):239-42.
Numerous concerns have been raised relative to the appropriateness of laparoscopic surgery for cure of rectal adenocarcinomas. However, because of their rarity, little information exists about the role of laparoscopy for other anorectal malignancies. We report the outcome of five patients who underwent laparoscopic surgery for other anorectal malignancies.
All patients who underwent laparoscopic surgery for treatment of non-carcinomatous anorectal malignancy were assessed by means of endoscopic, radiological and histopathologic diagnostic tests.
Two patients with anorectal melanoma and one with anal leiomyosarcoma underwent laparoscopic abdominoperineal resection. A laparoscopic loop ileostomy was performed for an HIV-positive patient with rectal Kaposi's sarcoma. Another patient with anorectal melanoma had intraoperative identification of distant liver metastasis and therefore underwent diagnostic laparoscopy instead of an intended abdominoperineal resection. There were no intraoperative laparoscopic complications. During the follow-up period three patients who underwent abdominoperineal resection were alive, one of whom had rectal melanoma and developed liver metastasis without local recurrence. The two patients with distant liver metastasis and rectal Kaposi's sarcoma died 46 days and five months after surgery, respectively. There were no port-site or local recurrences.
Laparoscopic abdominoperineal resection for non-carcinomatous anorectal malignancies is technically feasible and avoids many of the concerns associated with attempted curative laparoscopic resection of carcinoma.
对于腹腔镜手术治疗直肠腺癌的适宜性，人们提出了诸多担忧。然而，由于其他肛管直肠恶性肿瘤较为罕见，关于腹腔镜在这些肿瘤治疗中的作用，相关信息甚少。我们报告了5例接受腹腔镜手术治疗其他肛管直肠恶性肿瘤患者的治疗结果。
对所有接受腹腔镜手术治疗非癌性肛管直肠恶性肿瘤的患者，均通过内镜、影像学和组织病理学诊断检查进行评估。
2例肛管直肠黑色素瘤患者和1例肛门平滑肌肉瘤患者接受了腹腔镜腹会阴联合切除术。为1例患有直肠卡波西肉瘤的HIV阳性患者实施了腹腔镜袢式回肠造口术。另1例肛管直肠黑色素瘤患者术中发现远处肝转移，因此接受了诊断性腹腔镜检查，而非原计划的腹会阴联合切除术。术中无腹腔镜相关并发症。在随访期间，3例接受腹会阴联合切除术的患者存活，其中1例患有直肠黑色素瘤，出现肝转移但无局部复发。2例发生远处肝转移的直肠卡波西肉瘤患者分别在术后46天和5个月死亡。无切口部位复发或局部复发情况。
对于非癌性肛管直肠恶性肿瘤，腹腔镜腹会阴联合切除术在技术上是可行的，并且避免了与尝试性腹腔镜根治性切除癌相关的许多问题。
