经肛门微创手术全层切除腹膜返折上直肠肿瘤26例报道

目的探讨经肛门内镜显微手术(TEM)全层切除治疗腹膜返折以上直肠肿瘤的经验。 方法回顾性分析采用TEM全层切除治疗的26例腹膜返折以上直肠肿瘤患者的临床资料。 结果本组手术均顺利完成，其中1例术中联合腹腔镜下创面缝合，无手术相关死亡。手术时间70～150min，住院时间5～7d。术后无肠瘘，术后发生少量便血2例。腹腔感染1例经抗生素治疗痊愈。术后病理显示了与术前临床评估存在差异。26例(其中2例pT2期的患者追加了腹腔镜Dixon术)均获得随访，随访时间6～72个月，随访发现：术后病理证实为pT1期伴淋巴浸润1例患者，术后6个月时出现肿瘤原发部位复发，余均无复发(包括追加根治性手术的两例pT2期病例)。 结论TEM全层切除腹膜返折上方直肠肿瘤是安全的，同时提供了更详尽的病理信息，并更遵守肿瘤根治原则，值得临床推广。

Clinical analysis of transanal endoscopic microsurgery full-thickness excision in the treatment of rectal adenoma and early-stage carcinoma above peritoneal reflection(a report of 26 cases)

ObjectiveTo investigate outcomes of the full-thickness excision in the treatment of rectal adenoma and early-stage carcinoma above peritoneal reflection by transanal endoscopic microsurgery(TEM). MethodsThe clinical data of 26 cases who suffered from rectal adenoma and early-stage carcinoma above peritoneal reflection with TEM full-thickness resections were retrospectively analyzed. ResultsAll of the operations was successfully completed, one of which was combined with laparoscopy surgery for suturing wound, and there was no operation related death in the 26 cases.Operation time was 70~150 min, and the time of hospitalization was 5~7 d. There was no intestinal leakage after operation, 2 cases occurred a small amount of blood in the stool after operation and 1 case suffered abdominal infection which was cured by antibiotics.Postoperative pathology showed differences from the preoperative clinical assessment.All 26 cases(including 2 cases of pT2 patients with an additional operation of laparoscopic Dixon surgery)were followed up.The follow-up time ranged from 6 to 72 months.During the follow-up time, we found that one case that postoperative pathology confirmed pT1 stage with lymph node involved the primary tumor site developed recurrence 6 months after operation, the rest were recurrence free(including two patients with pT2 stage added to radicalsurgery). ConclusionTEM full-thickness resection in treatment of rectal adenoma and early-stage carcinoma above peritoneal reflection is safe, and provides more detailed pathological information, and more to comply with en bloc resection of tumor radical principle, and is worth of the clinical promotion.