Outcomes of Surgical Intervention for Retrorectal Tumor: Experience of Sixteen Patients in Chang Gung Memorial Hospital

直腸後腫瘤外科治療成果回顧：林口長庚16例的經驗回顧

張皓程(Hao-Cheng Chang) ； 王柏方(Po-Fang Wang) ； 江支銘(Jy-Ming Chiang) ； 唐瑞平(Rei-Ping Tang) ； 陳進勛(Jinn-Shiun Chen) ； 張簡俊榮(Chung-Rong Changchien) ； 王正儀(Jeng-Yi Wang)

《中華民國大腸直腸外科醫學會雜誌》 21卷2期 (2010/06) Pp. 87-94

https://doi.org/10.6312/SCRSTW.2010.21(2).09902

摘要

目的　發生於直腸後的腫瘤是一群組織病理上差異性極大的罕見疾病，其在臨床上的病徵與外科治療的角色甚少被討論與確定。
方法　本研究蒐集自1995至2008年間在本院接受外科治療的直腸後腫瘤個案，大腸直腸腫瘤與婦產科腫瘤並不被列入討論，吾人等分析其臨床上的病史、病理診斷、外科治療、以及外科治療的成果。
結果　共有16個案例被納入本研究，其中有5例是惡性腫瘤。良性腫瘤11例中有6例其症狀是極其不顯著，然而疼痛與壓迫症狀在惡性腫瘤的案例是顯著的。在14例接受電腦斷層與核磁共振造影檢查的結果顯示100%的診斷率。13、1、2個病患分別採取腹部、會陰、腹部合併會陰切除治療。畸胎瘤、發生囊腫、與許旺氏瘤是爲數最多的良性腫瘤，惡性腫瘤在本系列的病理診斷則差異極大。除了一個發生局部復發，所有的良性腫瘤都達到根除性外科治療的目的；相對的，所有的惡性腫瘤的個案都遭遇殘存或復發性疾病的問題，5個中有3個於1年內死亡，僅有1例存活至今。
結論　直腸後良性腫瘤臨床多以無症狀表現，相對的惡性腫瘤較常以疼痛或壓迫性徵候來表現。電腦斷層與核磁共振造影對診斷與術前計畫可提供充足有效的臨床資訊。良性腫瘤一般可藉根除性切除達到治癒的目的，惡性腫瘤的預後普遍不佳，因爲根除性切除在這些腫瘤是很不容易的。

關鍵字

直腸後 ； 薦骨前 ； 腫瘤 ； 腫塊

並列摘要

Background. Tumors originated from the retrorectal space are a rare group of diseases with diverse entities. The clinical features and surgical management of retrorectal tumors are seldom documented.
Materials and Methods. Medical records of adult patients receiving resection for retrorectal tumors during 1995 and 2008 were collected. Those patients with locally advanced colorectal or gynecologic adenocarcinoma were excluded. The clinical course, pathologic findings, associated treatment, and outcomes were assessed.
Results. A total of sixteen patients were included in this study, and five of them were diagnosed with malignant tumors. Benign tumors induced subtle symptoms and signs in 6 of 11 patients, while pain and other obstructive symptom were significant in malignant ones. Pelvic magnetic resonance image (MRI) and computerized tomography (CT) ascertained the diagnoses in all patients (14/14) accepting the examinations. Resections through abdominal, perineal, and combined approaches were introduced in 13, 1, and 2 patients respectively. Complete resection was achieved in 10 of 11 benign tumors but in none of malignant tumors. Teratoma, developmental cyst, and schwannoma were most common retrorectal benign tumors; on the contrary, pathologic result of retrorectal malignancies were diverse. All patients with benign tumors were disease free, except one experienced recurrence. However, all cases with malignant tumors were suffered from recurred or residual disease; three of them died within one year, whereas only one lived with disease.
Conclusion. Retrorectal benign tumors are frequently asymptomatic, while retrorectal malignancies more commonly manifest pain and compression symptoms. CT and MR scans provide sufficient information for diagnosis and preoperative therapeutic plans. Benign retrorectal tumors can be cured through complete resection; however, outcomes of malignant tumors are generally unsatisfied because of scarcely complete resection.

並列關鍵字

Retrorectal ； Presacral ； Tumor ； Mass