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目的探讨低位直肠绒毛状腺瘤癌变的合理手术方式。方法回顾性分析34例经肛门局部切除治疗的低位直肠绒毛状腺瘤癌变的临床资料。结果34例均有术后病理证实。其中高分化腺癌13例,中分化腺癌14例,高-中分化腺癌5例,低分化腺癌2例。肿瘤浸润黏膜层12层,浸润黏膜下层18例,浸润肌层4例。术后复发6例,转移4例。本组病例随访5年,失访3例,随访期间,死亡6例,余均存活至今。结论对于低位直肠绒毛状腺瘤癌变的患者只要符合适应证,施行经肛门局部切除治疗,既能达到根治术的疗效,又能保留肛门及排便功能,提高患者生活质量。
Objective To explore the reasonable operation method of carcinogenesis of low rectal villous adenoma. Methods The clinical data of 34 cases of low rectal villous adenomas treated with local anal resection were retrospectively analyzed. Results 34 cases were confirmed by postoperative pathology. There were 13 well-differentiated adenocarcinomas, 14 moderately differentiated adenocarcinomas, 5 high-to-middle-differentiated adenocarcinomas, and 2 poorly differentiated adenocarcinomas. The tumor infiltrated 12 layers of mucous membrane, infiltrated submucosa in 18 cases, and infiltrating muscle layer in 4 cases. 6 cases recurred after operation and 4 cases metastasized. This group of patients was followed up for 5 years and lost 3 cases. During the follow-up period, 6 cases died. The remaining cases survived to this day. Conclusions For patients with low rectal villous adenoma with canceration, as long as they meet the indications and perform transanal local resection, it can achieve the curative effect of radical surgery, but can retain the function of anus and defecation, and improve the quality of life of patients.