Clinical Experience with Posterior Surgical Approach to the Rectum

目的　直腸手術大部份是經由腹部前方途徑進行；但經後方途徑的優點是可以針對骨盆腔內的直腸及後直腸病變直接進行手術。我們針對這類手術，回顧我們的經驗並提出報告。方法　從1985年1月到2003年12月共計有21例病人，在本院接受經後方途徑施行直腸及後直腸病變的手術。其中男性病人有10例，女性病人有11例。（年齡從25至88歲）。這些直腸及後直腸病變，包括絨毛瘤，合併黏膜層癌之絨毛瘤，部份經選擇的早期直腸癌，有手術高風險之直腸癌，後直腸腫瘤及一些良性直腸病變。結果　接受經後方尾椎骨途徑直腸手術者有11例，經後方薦骨途徑手術者有4例，經後方括約肌剖開途徑手術者有6例。總計術後併發症，傷口感染者有5例，發生短暫性瘻管者有3例，但是並沒有病人因合併症需作大腸造瘻。經後方括約肌剖開手術病人並無肛門失禁，我們的病人並無因手術死亡。結論　根據我們的經驗，因擔心修補括約肌有肛門失禁的可能，經後方括約肌剖開途徑的手術越來越不盛行。如果需要對直腸及其周圍組織進行局部手術，若是不能經由肛門內視鏡手術或肛門局部切除手術，仍然可以經後方薦骨及尾椎骨途徑進行手術。手術不太難且病人可以接受，不過手術結果仍需長期追蹤。

關鍵字

直腸手術；經後方途徑；經薦骨途徑手術；後直腸病變；經尾椎骨途徑

並列摘要

Purpose. Most rectal surgery is done via the abdominal route. However, the posterior approach provides direct exposure to the local field. Under special circumstances, it is sometimes advantageous, if the rectal and retro-rectal lesion can be operated on locally. In this article, we review our experience with the posterior approach. Methods. From Jan. 1985 to Dec. 2003, 21 patients received a posterior surgical approach for rectal and retro-rectal lesions. There were 10 males and 11 females. Age ranged from 25 to 88 years. The category of diseases included villous adenoma with or without mucosal carcinoma, selected early rectal cancer, rectal cancer with high surgical risk, retro-rectal tumor and some benign rectal lesions. Results. The methods of posterior approach included trans-coccygeal (n=11), trans-sacral (n=4), and trans-sphincteric (n=6) approach. Postoperative complications included wound infection (n=5) and transient fecal fistula (n=3). No colostomy was required for complications. There was no anal incontinence over short-term follow up. There was no operative mortality. Conclusion. From our experience, Both trans-sacral and trans-coccygeal routes offer alternative approaches if the rectal lesions can not be dealt with transanally or endoscopically. (Local treatment via trans-sphincteric route is less ideal because of the continence problems). These approaches are simple and well tolerated by the patients. Further long-term follow-up is necessary to fully evaluate these approaches.

並列關鍵字

Rectal surgery ； Posterior approach ； Trans-sacral Kraske operation ； Retro-rectal lesion ； Trans-coccygeal

國際替代計量

Clinical Experience with Posterior Surgical Approach to the Rectum

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