Fifteen patients with rectal carcinoid tumors were treated from 1975 to 1991. Before admision, nine patients (60%) had been misdiagnosed as polyps ,hemorrhoids or proctitis. Diagnosis may be delayed because of failure to recognize their charasteristics and by the negligeuce of doing digital examination or proctoscopy. Some aspects of the management of these tumors remain controversial. However, present-day treatment programs call for radical cancer resections only for lesions 2cm in diameter or larger, and local resections for all others. In reviewing this series of cases and other studies, we advocate that both the size of the lesion and the depth of tumor invasion should be taken as the criteria of surgical managements. If the tumor is 2cm in diameter, or smaller than that, local resection can be performed, but whenever the nuscularis propria is invaded, radical resection should be performed. Radical resection is bly indicated for tumors larger than 2cm.
【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.
2.4 入路術前評估為臨床分期Ⅳ期無法切除的原發病灶，則手術選擇單純微創切口結腸造瘺……
３ 整體流程圖……
2.6.2.2 經骶直腸癌局部切除術（trans-sacrococcygeal resection,TSR）(1)ＴＳＲ手術指征①腫瘤部位: 部位是選擇TSR 的決定性因素之一,原則上腹膜返折以下的早期直腸癌均可通過TSR 完成,但理想部位是距齒狀線4～6 cm 的直腸癌,切口可直達病灶,在咬除尾骨后游離直腸范圍較小,得以輕松顯露接近腹膜返折甚至距肛緣8～10 cm 的直腸中段腫瘤。②腫瘤方位: TSR 最適合的還是直腸后壁或后側壁病變,前壁或前側壁腫瘤的直腸游離要做到界面層次清晰則需要術者具備相當的經驗。③腫瘤大小: 無論瘤體大小(瘤體直徑＜3 cm),腫瘤基底直徑應＜2 cm,尤其是淺潰瘍型腫瘤,還要考慮到直腸壺腹的寬窄大小。④腫瘤形態: TSR僅適合于息肉隆起型或扁平隆起型病變,也包括淺潰瘍型癌。⑤腫瘤浸潤深度: 腸腔內窺鏡超聲檢查理應成為術前分期的常規檢測手段和臨床指南,臨床上通過仔細檢查腫瘤基底活動度來判斷其浸潤..............