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目的:探讨经肛门汽化电切手术治疗直肠下段肿瘤性疾病安全性和可行性。方法:连硬膜外麻醉后患者取截石位,经肛门插入F25.5 Wolf前列腺汽化电切镜,4%甘露醇冲洗液持续低压灌洗。采用Spray电切模式,电切功率150 W,电凝功率60 W。用环状电极行局部病灶切除,冲出肿块组织。肿瘤基底部及创面彻底止血,放置肛管引流。距肛缘7cm以下的8例息肉,10例腺瘤伴上皮异型增生,29例直肠腺癌(T1期6例,T2期3例,T3期4例,T4期16例)接受汽化电切术,肿块大小约1～5 cm。结果:47例患者手术均顺利,手术时间15～90 min,平均40 min。23例T2-4期直肠癌患者中发生水中毒2例,经补充电解质、利尿后恢复正常;腹膜外肠穿孔3例,经肛门持续引流后痊愈;随访36个月,6例患者术后14～24个月因心脑血管或肺疾患死亡,2例因直肠癌广泛转移死亡;其余15例均全程随访,7例术后局部复发,再次行经肛门电切治疗;3例肝转移,2例腹腔转移。术后患者对生活质量满意度较高(70%)。8例直肠下段息肉和10例腺瘤及6例T1期直肠癌均全程随访,术后无肠穿孔、水中毒及肛门括约肌失禁等并发症,直肠镜检未见肿瘤复发。结论:经肛门直肠下段肿瘤汽化电切术安全有效、易于掌握,是局部切除直肠下段肿瘤的一种可选术式。
Objective: To investigate the safety and feasibility of transvaginal vaporization and resection for the treatment of lower rectal tumor. METHODS: The patients underwent epidural anesthesia for lithotomy. F25.5 Wolf prostatic eroscope, analgesia with 4% mannitol continued lavage. Using Spray mode, the power cut power of 150 W, coagulation power of 60 W. Rings with local excision of the electrode, out of the mass of the tumor. The base of the tumor and the wound completely stop bleeding, place the anal canal drainage. Eight polyps from the anal margin, 10 cases of adenoma with epithelial dysplasia, 29 cases of rectal adenocarcinoma (6 cases of T1, 3 cases of T2, 4 cases of T3, 16 cases of T4) underwent electrovaporization , The size of the tumor is about 1 ~ 5 cm. Results: All the 47 cases were operated smoothly, the operation time was 15 to 90 minutes, with an average of 40 minutes. Twenty-three cases of T2-4 rectal cancer patients had water poisoning in 2 cases. After electrolyte supplementation, diuretic returned to normal; 3 cases of peritoneal intestinal perforation cured by continuous anus drainage; 36 months follow-up, 6 cases of postoperative 14 ~ 24 months died of cardiovascular and cerebrovascular diseases, 2 patients died of extensive metastasis due to rectal cancer. The remaining 15 patients were followed up for full follow-up. Seven patients were locally recurred and were treated with anal resection. Three patients had liver metastases and two patients Abdominal metastasis. Postoperative patients were more satisfied with the quality of life (70%). 8 cases of lower rectum polyps and 10 cases of adenoma and 6 cases of T1 rectal cancer were followed up throughout the postoperative no intestinal perforation, water poisoning and anal sphincter incontinence and other complications, no rectal tumor recurrence. Conclusion: Transvaginal electrovaporization of the anorectal lower rectum is safe, effective and easy to grasp. It is an alternative surgical method for partial resection of the lower rectal tumor.