经肛门内镜手术治疗结直肠肿瘤可行性研究

目的 评估经肛门内镜显微手术治疗结直肠肿瘤的临床应用可行性,探讨手术中操作困难的处理策略。方法 回顾性分析上海交通大学医学院附属瑞金医院外科2006年9月至2008年6月期间36例经肛门内镜显微手术病人的临床资料。结果 36例病人均成功完成经肛门内镜显微手术,无中转开腹病例。平均手术时间为71（20~200）min。术后病理：腺瘤22例,腺癌8例,类癌5例,炎性肿块1例。术后平均住院时间为4.7（3~9）d。并发症方面：1例术后有肛门内出血,1例术后有暂时性排便失禁感。1例术后5个月发现直肠肿瘤复发。结论 经肛门内镜显微手术是一种对直肠中、上段及乙状结肠下段肿瘤有效、安全、可行性强的微创切除手术。严格选择病例,注意临床处理策略,经肛门内镜显微手术可取得和传统手术相仿甚至更优的结果,且住院时间短,并发症少,有良好的临床应用前景。     

经肛门内镜显微手术治疗直肠绒毛状腺瘤和早期直肠癌31例

目的探讨经肛门内镜显微手术（transanal endoscopicmic rosurgery，TEM）治疗直肠绒毛状腺瘤和早期直肠癌的疗效。方法1995年11月～2003年12月，我院行TEM治疗直肠肿瘤31例。全麻下根据肿瘤位置选择合适的体位，经肛门插入特殊的手术直肠镜，保持CO2充气状态，在立体视镜和腔镜系统下，采用针形电刀或5mm超声刀将直肠肿瘤完整切除（黏膜下或全层切除），手术创口在腔内连续缝合。结果31例直肠肿瘤均获完整切除，切缘均阴性。手术时间45～220min，平均95min；术中出血量0～180ml，平均40ml。手术并发症：暂时性排气失控2例，急性尿潴留1例，慢性阻塞性气道疾病急性发作1例，因服用阿斯匹林而出现继发性出血1例。术后病理分期：pT0期16例，pTis期2例，pT1期7例，pT2和pT3期各3例。31例随访2～92个月，平均23个月，肿瘤无原位复发。结论TEM是治疗直肠绒毛状腺瘤和早期直肠癌的一种安全、有效的微创手术方法。     

经肛门内镜显微手术切除直肠肿瘤的近况

经肛门内镜显微手术(transanal endoscopic microsurgery, TEM)是一种对直肠中、上段,乙状结肠下段肿瘤有效、安全、可行性强的外科切除技术,由Buess设计发明,并于1983年首次报道.TEM符合肿瘤学原则,对严格选择的病例可取得和传统手术相仿甚至更好的效果,且住院时间短,并发症少.本文对TEM的特殊器械及手术方法、适应证、临床应用结果、并发症等进行综述,并对笔者的初步经验进行概括.     

经肛门内镜显微手术治疗直肠肿瘤12例

为探讨经肛门内镜显微手术（TEM）治疗直肠肿瘤的手术效果,回顾分析12例行TEM的直肠肿瘤患者资料。结果显示,12例直肠肿瘤均获完整切除,平均手术时间90min（60-200min）。无术后出血、吻合口感染、吻合口漏。2例术后肛门轻度疼痛,2例暂时性不完全性肛门失禁。术后病理示9例腺瘤（管状腺瘤3例,绒毛状腺瘤4例,管状绒毛状腺瘤2例,其中2例伴高级别上皮内瘤变）,1例肌层内有钙化灶,1例直肠黏膜炎性组织,1例低危间质瘤（直径〈1．0cm）。随访1～12个月,1例管状腺瘤患者于术后3个月局部复发。结果表明,TEM治疗良性直肠腺瘤和早期直肠癌安全、有效。     

经肛门内镜显微手术局部切除早期直肠癌后续治疗策略对临床结局影响研究

目的 探讨经肛门内镜显微手术（TEM）局部切除早期直肠癌后续治疗方式的选择。方法 回顾性分析北京协和医院于2013-2019年间收治的105例经TEM切除直肠癌病人资料,所有病人均在知情同意后接受TEM。结果 105例病人经术前检查［直肠腔内超声和（或）直肠MRI］评估为cT1期且除外淋巴结转移,经病理学活检报告为腺瘤局部癌变或者直肠腺癌,均通过TEM完成直肠癌的局部扩大切除。105例病人术后36例行补救性根治性手术,29例行补救性放化疗,40例仅随访观察。105病人术后接受平均40（12～69）个月随访。随访期间,13例（12.4%）局部复发,2例（1.9%）远处转移,3例（2.9%）死亡。单因素分析结果显示,T分期（P=0.003）、是否R0切除（P＜0.01）和术后处理策略（P=0.036）是复发及死亡预测因子。在多因素分析中,T分期（HR 7.36,95%CI 1.82~29.85,P=0.005）、是否R0切除（HR 20.82,95%CI 2.71~159.64,P=0.003）及术后处理策略（HR 0.57,95%CI 0.08~0.38,P=0.003）与复发及死亡密切相关。结论 TEM局部切除pT1期直肠癌安全、有效。而对于pT2期或未达R0切除直肠癌病人术后复发风险高,后续积极采取根治术或辅助放化疗的补救性治疗可提高病人预后。     

经肛门内镜显微手术治疗直肠肿瘤(附7例报道)

目的探讨经肛门内镜显微手术(TEM)治疗直肠肿瘤的疗效。方法回顾性分析2009年1~12月期间我院行TEM治疗7例直肠腺瘤患者的临床资料。结果 7例直肠肿瘤均获完整切除,切缘均阴性。手术时间55~240 min,平均110 min;术中出血量5~100 ml,平均45 ml。术后病理诊断:直肠绒毛状腺瘤4例,绒毛管状腺瘤2例,直肠腺癌1例。手术并发症:术中直肠穿孔1例,肺部感染1例,尿潴留1例。7例随访6~13个月,平均8个月,肿瘤无复发。结论 TEM治疗直肠肿瘤安全、有效。     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

探讨经肛门内镜显微手术(TEM)在治疗局限性直肠肿瘤中的应用效果.方法 总结分析2006年4月至2008年12月接受TEM的75例直肠肿瘤患者的临床资料,分析TEM在直肠肿瘤治疗中的应用效果.结果 患者病灶平均直径为(1.6±0.8)cm(0.5～5.0 cm).病灶距肛缘平均(7.6±2.8)cm(5～20 cm).病灶在直肠内的部位:前壁25例,后壁24例,左侧壁14例,右侧壁12例.手术方式包括:肠壁全层切除64例,黏膜下及肌层部分切除11例.平均手术时间(73.7±32.1)min(30～180 min),术中平均失血(9.8±7.7)ml(3～50 ml).术后病理检查:直肠腺瘤28例,直肠腺瘤癌变和直肠癌25例(其中Tis期14例,T1期5例,T2期6例),直肠类癌7例,炎性息肉等15例.所有标本切缘均为阴性.全组术后4例(5.3%)发生并发症,其中并发肛门出血2例,肺部和泌尿系感染各1例.术后平均住院(3.4±1.2)d(2～7 d).术后平均随访8.4个月(3～26个月),未发现疾病或肿瘤有复发转移.结论 TEM治疗直肠肿瘤具有手术损伤小,出血少、疗效好、恢复快等优点,是目前直肠肿瘤局部切除的较佳方法.     

直肠肿瘤经肛门内镜显微手术后并发症的护理

对134例直肠肿瘤患者行经肛门内镜显微手术,术后发生肛门出血3例,肺部感染1例,泌尿系感染1例,拔除尿管后尿潴留2例,肛门功能障碍、肛周水肿不适4例,术中切穿肠壁至腹腔5例;术后病理检查提示需行二次直肠癌根治术3例。对16例患者予及时的对症处理、精心的护理干预后痊愈出院。提出直肠肿瘤经肛门内镜显微手术具有损伤小、出血少、恢复快等优点,但术后并发症不容忽视,需密切观察,早期发现并及时处理,才能保障手术安全。     

经肛门内镜微创手术治疗直肠肿瘤

经肛门内镜微创手术（transanal endoscopic microsurgery,TEM）是一种经肛门切除肿瘤的微创保肛手术方法,集内镜、腹腔镜和显微手术三种技术特点于一身,在手术时间、出血量、术后镇痛、平均住院时间方面均显著优于经腹手术,较传统的局部切除术具有明显的优点。     

经肛门内镜显微手术在直肠肿瘤局部切除术中的应用

目的初步评价经肛门内镜显微手术(transanalendoscopicmicrosurgery,TEM)在直肠肿瘤局部切除术中的应用。方法2006年4月至9月对8例直肠肿瘤患者采用TEM行局部切除术。术前根据直肠腔内超声肿瘤分期uT0期6例,uTis期和uT1期各1例。肿瘤距肛缘距离平均7(4~9)cm;肿瘤直径平均1.5(1~2.5)cm;肿瘤占据肠腔周径比例平均20%(10%~30%)。结果8例直肠肿瘤均获完整切除(粘膜下切除3例,全层切除5例),各切缘均阴性。手术时间平均50(40~60)min;术中平均出血量30(10~50)ml。术后住院天数平均5(2~7)d。无一例出现手术并发症。术后病理分期pT0期5例,pTis期、pT1期和pT2期各1例。8例术后随访平均3(1~5)个月,肿瘤无局部复发。结论TEM显露良好、切除精确,手术安全、创伤小,经严格选择病例可用于良性直肠肿瘤和早期直肠癌的彻底切除。     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.     

经肛门内镜显微手术治疗直肠腺瘤和早期直肠癌21例

对于直肠直径较大、广基底的良性肿瘤和早期恶性肿瘤。肠镜下切除困难,通常需采用经肛、经骶或经腹等手术治疗,这些术式操作复杂、创伤大且并发症多。经肛门内镜显微手术（transanal endoscopic microsurgery,TEM）兼备了内镜、腹腔镜和显微手术的优点,其术野暴露良好、切除精确、获取病理标本满意、术后并发症少及住院时间短．且能最大限度地保留肛门功能从而避免永久性造口,为直肠肿瘤的治疗提供了新的选择…。吉林大学第二医院普通外科2011年6月至2012年6月应用TEM治疗21例直肠肿瘤患者。现总结如下。     

经肛门内镜微创手术在治疗局限性直肠肿瘤中的应用

Objective To investigate the therapeutic effect of transanal endoscopic microsurgery (TEM) for localized rectal neoplasms. Methods Seventy-five patients with localized rectal neoplasms were treated by using TEM between April 2006 and December 2008. The clinical data was summarized and analyzed retrospectively to report the therapeutic effect of TEM in these cases. Results The mean diameter of the rectal lesions was (1.6 ± 0.8) cm (range, 0.5-5.0 cm). The average distance of lesions from the anal verge was (7.6 ± 2.8) cm (range, 5-20 cm). Locations of the lesions at the rectal wall : 25 located at the anterior wall, 24 at the posterior wall, 14 at the left wall and 12 at the right walL Surgical procedures included the transmural excision (64 cases) and the submucosal excision with partial muscular layer excision (11 cases) was performed. The average operating time was (73.7±32.1) win (range, 30-180 min). The mean operative blood loss was (9. 8 ± 7.7) ml (range, 3-50 ml). The postoperative pathological examination identified 28 cases of rectal adenoma, 25 rectal adenocarcinoma or carcinomatous changes of adenoma (14 cases with phase Tis tumor, 5 cases T1 and 6 cases T2), 7 rectal carcinoid and 15 cases of inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications occurred in 4 cases (5.3%), included 2 cases of anal hemorrhage, 1 case of pulmonary infection and 1 urinary infection. The average postoperative hospital stay was (3.4 ± 1.2) d (range, 2-7 d). All the patients were followed-up for a mean period of 8.4 months (range, 3-26 months), no tumor recurrence or metastasis was observed. Conclusion Being a kind of minimally invasive surgery, TEM shows advantages of decreased blood loss, better therapeutic effect and faster recovery, and it is a better choice of procedure for local excision for rectal neoplasms.