目的探讨低位直肠息肉恶变的合理的外科手术方式。方法对我院1997年1月至2001年12月收治的32例低位直肠息肉恶变患者的资料进行回顾性分析。 结果32例中经肛门局部切除20例，经腹前切除低位吻合（Dixon术）8例，经腹会阴联合切除（Miles’术）4例，其中27例术后给予放、化疗。28例获随访1~5年，2例死亡，余均无局部复发。 结论低位直肠息肉恶变手术方式的正确选择是达到“根除癌肿”、“改善患者生活质量”目的的关键，术中冰冻病理检查是手术方式选择的重要依据。
Out of 4500 patients with gastro-intesinal disorders coming to our department from January 1970 to May 1994,31 of them were fund to be suffering from gastric adenomotous polyps(GAP).The detective rat of GAP was 0.7% with two malignant adenomatous polyps detected and 13 percent of GAP cases complicated with adenocarcinoma of the stomach(4/31).The size of the polyps is closely relevant to the malignant change.Twelve patients underwent surgical therapy and 19 gastrocopic polypectomy.On follow up.2 cases of recurrence were detected in both surgical and endoscopic removal proups.
ObjectiveTo investigate the correlation between tumor-vessel signs on 64-slice spiral CT (MSCT) and malignant change of tubulovillous adenoma in the colon and rectum. MethodsA retrospective study of the image and the clinical data of 16 patients with tubulovillous adenoma or malignant change proved by pathologies from February 2010 to October 2012 was conducted. The tumor-vessel signs were analyzed by multiplanar reformation (MPR) and maximum intensity projection (MIP) on picture archiving and communication systems workstation. ResultsAmong the 16 cases of tubulovillous adenoma or malignant change, 2 cases of tumor diameter≤2 cm had no tumor-vessel sign; and in the 14 cases of tumor diameter >2 cm, 13 were observed to bear tumor-vessel signs. The size of the tumor and tumor-vessel signs showed a certain correlation (r=0.618, P=0.002). And the manifestation of tumor-vessel signs had obvious differences between benign and malignant tumor. For the adenoma group, it showed venous blood vessel involvement, and downy and natural contour; for the adenocarcinoma group, it showed arterial blood vessel involvement, blood vessels with uneven thickness, visible expansion and irregular defect manifestations. No obvious difference was detected among tumor-vessel signs of adenocarcinoma with different malignant degree. ConclusionMSCT combined with image reconstruction techniques (such as MPR and MIP) can clearly demonstrate tumor blood supply, and tumor-vessel in the arterial phase may suggest a high risk of malignant change of tubulovillous adenoma in the colon and rectum.