【作者】 王斌； 王辉；

【Author】 Wang Bin et al,Liaoning Tumor Hospital (110042)

【机构】 辽宁省肿瘤医院；

【摘要】 目的探讨直肠平滑肌肉瘤的诊断和治疗。方法对经病理证实的直肠平滑肌肉瘤27 例进行分析,并系统论述其临床表现,诊断,鉴别诊断及治疗。结果 27例直肠平滑肌肉瘤主要临床症状,肛门部坠痛,大便变形、便细、便秘、便血,排尿困难。直肠指诊26例位于距肛缘5cm之间, 1例位于5cm以上。直肠粘膜光滑者24例,肿瘤最大直径2～10cm,平均6cm。术前活检确诊4例, 诊断率15％。术后病理检查无一例有局部淋巴转移,25例行miles手术。2例行局部切除后肿瘤复发行二次miles手术。随访27例,3年生存率为52％。5年生存率为37％。结论 1．直肠平滑肌肉瘤诊断靠临床症状及直肠指诊,因肿瘤多末穿透直肠粘膜,经结肠镜活检诊断率低,应在麻醉下取足量肿瘤组织病理检查。2．与直肠平滑肌瘤鉴别诊断依靠:①瘤体≥6cm。②肿瘤坏死,出血囊性变。③显微镜下肿瘤细胞异型显著,每10个高倍视野可见到1个以上核分裂象。④瘤细胞对周围组织浸润。⑤肿瘤细胞DNA含量分析多为异倍体肿瘤。3．本病对化疗,放疗不敏感。手术治疗是唯一有效方法,局部切除复发率高,且有可能发生远处转移,因而切除范围应尽可能广泛。只要病者情况允许,均应行miles手术。因其以血行转移为主,不强调淋巴结清除。更多还原

【Abstract】 Objective to evaluate diagnosis and treatment of rectal liomyosarcoma. Methods The report of 27 cases with rectal liomyosarcoma was reviewed and the following information analyzed systemically. 1. clinical manifestation, 2. diagnosis, 3. differential diagnosis, 4. Treat- ment. Results climical manifestation in 27 cases included proctagia,irregular bowel movement. constipation,passing blood in stool and dysuria. Tumor of 26 cases was located in 5 cm between anal brim and tumor. Smooth of rectal mucosa was 25 cases. Maxinum diameter of tumor was 2cm to 10cm,meaning 6cm. Only 4 cases or 15 pecent were tietified Liomyosarcomel by preoperative biopsy. 25 cases umderwent abdominoperineal resection. 2 cases undertwent secondary ab- dominoperineal reseetion becouse of local reccurence ofter local reseetion. The survuval rate of 3 years was 52 persent and 5 years was 37 persent. Conclusion 1. diagnosis of liomyosarcoma de- pends on clinical manifestation and rectal examination preoperative biopey has low diagnosical rate becouse major tumor place under recta musosa. 2. Differential diagnosis with rectal liomyoma depends on: 1. Tumor≥6cm 2. bleeding,mecrosis of tumor 3. mitosis 1—2/10HFP 4. contiguous infiltration of tumor cell. 5. neccploid meoplama in DNA analysis. 3. Abdominoperineal resection is the best way to treat rectal liomyosareoma,local resection can couse local reccurence and metasta- sis, it is not sensitive to chemotherapy and radiotherapy, lymphatic resection is not needed because rectal liomyosarcoma maily is blood spread.更多还原