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직장의 융모성 선종에 대한 외과적 고찰

Surgical Review of the Rectal Villous Adenoma

대한대장항문학회지 1999년 15권 4호 p.301 ~ 306
이종호 ( Lee Jong-Ho ) - 성균관대학교 의과대학 강북삼성병원 외과학교실

김흥대 ( Kim Heung-Dae ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
손병호 ( Son Byung-Ho ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
유창학 ( Yoo Chang-Hak ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
박용래 ( Park Yong-Lai ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
신준호 ( Shin Jun-Ho ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
김용신 ( Kim Yong-Shin ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
한원곤 ( Han Won-Kon ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
배원길 ( Bae Won-Gil ) - 성균관대학교 의과대학 강북삼성병원 외과학교실
김광연 ( Kim Kwang-Yeon ) - 송도병원 외과

Abstract


Purpose: This study was undertaken to evaluate retrospectively the clinical results of surgery for the rectal villous adenoma.

Methods: The study took place from the period of Mar. of 1988 to Feb. 1998 at the Dept. of Surgery, Sungkyunkwan Univ., Medical college. The study consisted of : Among the 97 cases diagnosed with colon & rectal villous adenoma, and 59 were rectal villous adenoma, and 42 cases underwent resection. We focused on these 42 cases, especially on the position of tumor, its size, surgical technique, histologic results & keeping close follow up post- surgically.

Results: The sex ratio was 2:1 with male predominence, 18 cases were in their fifties with the average age of 55. In 30 cases, the lesion was situated within the 8 cm of anal verge. The average size of tumor was 3.64 cm. The applied methods were; rectotomy 19 cases, anterior resection 13 cases (including low anterior resection), endoscopic excision and transanal excision were 7 cases, and 2 cases, respectively. And in one case where the tumor size was 14.5 cm and which was situated within 3 cm of anal verge, Miles’ operation was conducted. Death due to post-operative complication was not observed. 2 cases of wound infection in postoperation, one case of transient urinary incontinence & hematoma were found. And in the case of explo-laparotomy, anastomosis site leakage, in one case, anastomosis site stricture in 2 cases were noted. malignant cells were observed in total of 73.8%, among these, 80% were from villous adenoma, 70% from tubullovillous adenoma. In the case of tumor size less 1 cm, and tumor size greater than 1 cm, the probability of finding malignant lesion were 33.3% and 76.9%, respectively.

Conclusion: We suggest that wide excision through York-Mason approach is a safe and effective technique for huge villous adenomas of the rectum.

키워드

Villous adenoma;Posteroir rectotomy;York Mason approach
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