【医编重难点】直肠癌的表现与治疗
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">1、</span>概述</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠癌为最<span style="color: black;">平常</span>的大肠癌。其组织学分型中最常<span style="color: black;">出现</span>的为腺癌，<span style="color: black;">重点</span>经淋巴转移。上段直肠癌<span style="color: black;">重点</span>转移至直肠上动脉、肠系膜下动脉和腹主动脉<span style="color: black;">周边</span>淋巴结；下段直肠癌可转移至腹股沟淋巴结。血行转移<span style="color: black;">重点</span>转移至肝。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">2、</span>临床表现</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（1）<span style="color: black;">重点</span>症状：①直肠刺激征，表现为排便不尽感、肛门下坠感、里急后重等，<span style="color: black;">初期</span>可见排便习惯改变，晚期有下腹痛；②局部最<span style="color: black;">平常</span>的表现为便血（报警症状），若癌肿破溃感染可<span style="color: black;">显现</span>脓血便；③因癌肿侵犯使肠腔狭窄而<span style="color: black;">引起</span>大便变形、变细，<span style="color: black;">乃至</span><span style="color: black;">显现</span>低位肠梗阻的症状；④若癌肿侵犯前列腺可<span style="color: black;">显现</span>尿频、尿痛；<span style="color: black;">损害</span>骶前神经可<span style="color: black;">显现</span>骶尾部<span style="color: black;">连续</span>性剧痛；若<span style="color: black;">显现</span>肝转移则有肝大、腹腔积液等表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（2）体征：①直肠指检可触及肿物，<span style="color: black;">认识</span>肿物的部位、<span style="color: black;">体积</span>、质地、形状、至肛缘距离及指套染血等<span style="color: black;">状况</span>；②腹股沟淋巴结肿大，多见于齿状线以下的直肠癌；③并发肠梗阻时，可见腹部膨隆、肠鸣音亢进；④晚期有肝转移表现（肝大、黄疸、移动性浊音阳性）及恶病质表现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">3、</span>手术<span style="color: black;">办法</span>及适应证</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">直肠癌的<span style="color: black;">重点</span>治疗<span style="color: black;">办法</span>为手术治疗（首选）。术式的<span style="color: black;">选取</span>应<span style="color: black;">按照</span>癌肿所在位置、<span style="color: black;">体积</span>、肿瘤活动度、细胞分化程度及<span style="color: black;">掌控</span>排便能力等<span style="color: black;">原因</span>综合判断。临床上将直肠癌分为低位直肠癌（距齿状线5cm以内）、中位直肠癌（距齿状线5～10cm）、高位直肠癌（距齿状线10cm以上），这种<span style="color: black;">归类</span>对直肠癌根治手术方式的<span style="color: black;">选取</span>有<span style="color: black;">要紧</span>的参考价值。直肠癌远端肠壁浸润<span style="color: black;">通常</span>在2cm以内，手术时切缘需距肿块下缘2cm以上。若侵犯子宫，可行后盆腔脏器清扫；若侵犯膀胱，可行全盆腔清扫。</p>
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