肛门内镜下11O例直肠肿瘤切除术

目的 探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤的效果.方法 总结2006年4月至2009年8月接受TEM的110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 患者病灶直径0.5～5.5 cm,平均直径为(1.7±0.8)cm.病灶距肛缘4～20 cm,平均距离为(7.4±2.6)cm.病灶在直肠内的部位:前壁40例,后壁29例,左侧壁22例,右侧壁19例.手术方式:肠壁全层切除98例,黏膜下及肌层部分切除12例.手术时间25～180 min,平均(73.5 ±31.0)min;术中失血3～60 ml,平均失血(10.8±7.8)ml.术后病理学检查:直肠腺瘤41例,直肠腺瘤癌变和直肠癌35例(其中Tis期21例,T1期6例,T2期8例),直肠类癌14例,直肠间质瘤1例,直肠平滑肌瘤1例,炎性息肉等18例.所有标本切缘均为阴性.术后并发肛门出血2例,肺部和泌尿系感染各1例,并发症发生率为3.6%(4/110).术后住院日2～8 d,平均住院日(3.4±1. 3)d.术后平均随访12.5个月,未发现肿瘤复发和转移.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,是目前直肠局限性肿瘤局部切除的首选方法.     

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.     

经肛门内镜显微手术治疗直肠神经内分泌肿瘤

目的探讨经肛门内镜显微手术(TEM)直肠全层切除治疗直肠神经内分泌肿瘤的效果。方法回顾性分析北京协和医院2006年12月至2015年12月间74例采用TEM治疗的直肠神经内分泌肿瘤患者。收集患者的一般资料、肿瘤特点、手术情况、术后病理及随访结果。结果其中50例患者行原发病灶切除,24例患者因结肠镜下切除后标本切缘不清或阳性行二次手术。肿瘤直径平均(1.02±0.43)cm,距离肛缘(7.9±1.7)cm。平均手术时间(58.7±12.1)min,平均术中出血量(13.1±5.0)ml。所有标本基底和侧切缘均阴性。平均随访3.6年,无肿瘤复发。结论 TEM可以作为直径较小的中上段直肠神经内分泌肿瘤手术治疗的首选。     

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。     

经肛门微创系统治疗45例直肠肿瘤的临床分析以及经肛门内镜微创手术的进展

目的探讨经肛门内镜微创手术(TEM)治疗直肠肿瘤的安全性、疗效及预后,评价其临床应用价值及文献复习。方法回顾性分析2014年8月至2017年2月期间于佛山市第一人民医院行TEM治疗的45例直肠肿瘤患者的临床资料,总结其临床效果。结果所有患者的肿瘤病灶均完整切除,肿物直径为1.8±0.8 cm(1.0~4.0 cm),肿瘤距离肛缘为7.6±2.8 cm(6~17 cm);切缘行病理学检查均为阴性,其中全层切除18例,粘膜下及肌层部分切除27例;手术时间为72.7±18.1 min(40~120min),术中失血量的中位数为16.6 m L(5~200 m L);术后住院时间为4.9±1.7 d(4~7 d)。术后病理学检查示单纯直肠腺瘤13例,绒毛管状腺瘤13例,腺瘤伴低级别上皮内瘤变5例,腺瘤伴高级别上皮内瘤变7例,腺瘤癌变5例,均为Tis~T1期;另直肠类癌2例。术后发生创面大出血3例,均经保守治疗治愈;5例肛管及内痔损伤出血术中需加缝肛管创面;无大便失禁及肠穿孔情况。39例患者包括5例癌变患者术后常规随访,随访时间的中位数为15个月(2~30个月),随访期间均未出现肿瘤局部复发,未发生大便失禁和排便功能障碍。结论我们的结果与文献报道结果相近。TEM具有直视下操作、术野暴露清晰、切除范围准确、手术创伤小、复发率低等优点,是一种可用于治疗直肠肿瘤有效的、安全的微创手术方法,应在有条件的医院开展。     

经肛门内镜微创手术治疗直肠肿瘤

目的评估经肛门内镜显微手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤临床应用的安全性、可行性及疗效,探讨手术中操作难点的处理策略。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2010年2月期间53例经肛门内镜显微手术病人的临床资料。结果共53例直肠肿瘤病人接受TEM手术治疗,其中直肠腺瘤28例,直肠类癌7例,直肠癌15例,炎性肿块2例,淋巴瘤1例,96.2%病人切缘阴性。术后并发症:2例肛门出血,1例急性尿潴留,1例肺部感染,1例暂时性排便失禁。术后平均住院天数为4.8(3~9)d。平均随访23(2~43)个月,腺瘤组出现2例复发,腺癌组出现2例复发,类癌组无复发。结论 TEM是一种对直肠中、上段及乙状结肠下段肿瘤安全、有效的微创手术方法。     

经肛门内镜微创手术治疗直肠肿瘤疗效的临床分析(附26例报道)

目的探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤的疗效及预后,评价其临床应用价值。方法回顾性分析2012年8月至2014年11月期间于青岛大学附属医院行TEM治疗的26例直肠肿瘤患者的临床资料,总结其临床效果。结果所有患者的肿瘤病灶均完整切除,切缘行病理学检查均为阴性。手术时间为(70.7±22.1)min(40~120 min),术中失血量的中位数为9.8 m L(5~30 m L);术后住院时间为(5.4±2.2)d(4~9 d)。术后病理学检查示单纯直肠腺瘤12例,腺瘤伴低级别上皮内瘤变8例,腺瘤伴高级别上皮内瘤变2例,腺瘤局灶癌变2例,均为T 1期;直肠类癌2例。术后发生大便带血1例,一过性大便失禁2例。26例患者术后均获访,随访时间的中位数为9个月(6~18个月)。随访期间均未出现肿瘤局部复发,未发生控便和排便功能障碍。结论 TEM的术野暴露良好、切除范围准确、术后恢复快、复发率低,是一种可用于治疗直肠肿瘤,特别是位于直肠中上段的良性肿瘤及早期直肠癌的安全而有效的微创手术方法。     

39例直肠间质瘤局部切除的临床效果分析

目的探讨经肛门内镜切除直肠间质瘤的可行性与安全性。方法回顾性分析2013年1月至2018年12月经肛门内镜胃肠手术(TEM)技术切除直肠间质瘤患者资料,其中男性患者24例,女性患者15例,平均年龄(57.3±13.1)岁。39例患者均由统一手术团队进行手术及围术期管理,随访8~68个月。结果39例直肠间质瘤患者在TEM下均成功切除病灶,无输血无中转开腹。术中平均出血量(10.4±3.7)ml,平均手术时间(50.3±9.8)min,无严重并发症发生。切除肿瘤平均大小(3.3±1.4)cm,术后病理证实为间质瘤,平均住院时间(7.9±2.3)d。随访期间复发1例(2.6%),转移3例(7.7%)。1例(2.6%)复发患者再次行TEM术后目前并且稳定;2例(5.1%)患者肝转移,1例(2.6%)发生骨转移,其中2例(5.1%)死亡。结论经TEM治疗直肠间质瘤安全可行,具有术中出血少、手术时间短、住院时间短等优点。     

腹腔镜微创治疗高龄完全性直肠脱垂

目的探讨腹腔镜微创治疗高龄完全性直肠脱垂的手术方法,总结手术操作体会及临床治疗经验。方法总结2012年6月~2017年6月收治的22例完全性直肠脱垂患者的临床资料,患者年龄67~79岁,均在腹腔镜下行悬吊固定。结肠造影和术中均可见明显增厚且冗长的乙状结肠,直肠周围组织宽松,膀胱直肠窝或子宫直肠窝之间脂肪结缔组织明显增厚,尤其是直肠前壁。术中切除直肠周围增厚的脂肪结缔组织,切除冗长的乙状结肠和直肠上端,行结肠直肠吻合。结果所有患者手术顺利,无中转开腹。手术时间平均(86.59±14.84)min,出血量平均(63.41±23.67)ml,术后住院时间平均(10.01±1.57)d。无吻合口出血、感染、肠瘘等并发症发生,无术中死亡或术后2周内死亡病例。22患者均获得临床治愈,随访2~4年,平均(2.81±0.91)年,患者排便次数1~2次/d,肛门功能正常,无复发。结论腹腔镜下微创切除直肠周围增厚的结缔组织、切除冗长的乙状结肠和直肠上端,是一种较好的微创治疗高龄直肠脱垂的方法。     

Transanal endoscopic video-assisted (TEVA) excision

Background

Transanal endoscopic video-assisted (TEVA) excision represents an alternative approach for the surgical treatment of middle and upper rectal lesions not amenable to colonoscopic removal. Utilizing principles of single-incision laparoscopic surgery, this novel minimally invasive approach optimizes access for safe and complete removal of these lesions without the need for a formal rectal resection. We describe our technique and early outcomes with TEVA excision.

Methods

Between March 2010 and September 2011, TEVA excision was performed for patients presenting for management of rectal lesions not amenable to colonoscopic or standard transanal removal. Patients were selected if they presented with benign disease or superficial adenocarcinoma, and the proximal extent of the lesion extended beyond 8?cm from the anal verge. Demographic, intraoperative, and postoperative data were assessed. A SILS? port was placed in the anal canal for access in all cases. Standard laparoscopic instruments were utilized for visualization, full-thickness transanal excision, and primary closure.

Results

Twenty patients (50?% male) with a mean age of 64.6?±?10.9?years, mean body mass index of 28.2?±?4.9?kg/m², and median American Society of Anesthesiologist score of 2 underwent TEVA excision. Fourteen patients (70?%) presented with benign disease and six patients (30?%) presented with malignant disease. The mean size of the lesions was 3.0?±?1.4?cm, and the mean distance from the anal verge was 10.6?±?2.4?cm. All excisions were successfully completed with a mean operative time of 79.8?±?25.1 (range, 45?C135) min. The mean length of hospital stay was 1.1?±?0.7 (range, 0-3) days.

Conclusions

TEVA excision is a safe and feasible approach for local excision of rectal lesions not otherwise amenable to standard techniques. Continued investigation and development will be important to establish its role in minimally invasive colorectal surgery.     

Transanal endoscopic microsurgery for carcinoma of the rectum

Background The authors present their experience with rectal cancers managed by transanal endoscopic microsurgery (TEM). Methods This prospective study investigated patients undergoing primary TEM excision for definitive treatment of rectal cancer between January 1996 and December 2003 by a single surgeon in a tertiary referral colorectal surgical unit. Results For this study, 52 patients (30 men and 22 women) underwent TEM excision of a rectal cancer. Their mean age was 74.3 years (range, 48–93 years). The median diameter of the lesions was 3.44 cm (range, 1.6–8.5 cm). The median distance of the lesions from the anal verge was 8.8 cm (range, 3–15 cm), with the tumor more than 10 cm from the anal verge in 36 patients. The median operating time was 90 min (range, 20–150 min), and the median postoperative stay was 2 days. All patients underwent full-thickness excisions. There were 11 minor complications, 2 major complications, and no deaths. The mean follow-up period was 40 months (range, 22–82 months). None of the pT1 rectal cancers received adjuvant therapy. Eight patients with pT2 rectal cancer and two patients with pT3 rectal cancer received postoperative adjuvant therapy. The overall local rate of recurrence was 14%, and involved cases of T2 and T3 lesions, with no recurrence after excision of T1 cancers. Three patients died during the follow-up period, but no cancer-specific deaths occurred. Conclusions The findings warrant the conclusion that TEM is a safe, effective treatment for selected cases of rectal cancer, with low morbidity and no mortality. The TEM procedure broadens the range of lesions suitable for local resection to include early cancers (pTis and pT1) and more advanced cancers only in frail people.     

Transanal endoscopic microsurgery: where are we now?

AIMS: This review of literature aimed to assess the role and establish the current status of transanal endoscopic microsurgery (TEM) in the management of benign and malignant rectal lesions. METHODS: A review of the literature was undertaken through the Medline database and by cross-referencing previous publications, thus identifying 54 relevant publications on TEM in the management of rectal lesions. Aggregated results of various parameters were calculated but statistical comparisons deemed unsuitable due to heterogeneity of data. RESULTS: The TEM procedure is associated with good functional results, morbidity of 4% and zero procedure-related mortality. The local recurrence rates after TEM excision is 4.5% (range 0-14) for benign rectal lesions, 6% (0-13) for T(1) cancers, 14% (range 0-50) for T(2) cancers and 20% (range 14-67%) for T(3) cancers. Local recurrences after TEM can be surgically salvaged with good disease free survival rates. CONCLUSIONS: The TEM procedure clearly offers the benefits of good exposure of the operative field allowing extremely precise dissection and access to high rectal lesions unresectable by other methods. For pTis and low risk pT(1) lesions, the oncological results are comparable to the more traditional formal resection. The routine use of TEM for high-risk pT(1) and higher stage lesions is not an oncologically sound choice at the present moment.     

Transanal endoscopic microsurgery: a necessary requirement?

INTRODUCTION: There has been a gradual introduction of transanal endoscopic microsurgery (TEM) into UK practice although the uptake remains variable. This study aimed to assess the availability, application and referral pattern of TEM amongst colorectal surgeons. METHODS: A questionnaire was sent to all consultant members of the Association of Coloproctology. This considered their practice, the availability, application and referral pattern for TEM, and their views on application regarding a selection of rectal tumour scenarios. RESULTS: There were 142 replies representing 116 hospitals and 297 colorectal surgeons. The median catchment area was 280,000 (range 70,000-1,000,000). TEM was available in 18% of hospitals and 72% either performed or referred patents for TEM. Of 21 units performing TEM, 15 received referrals. From 305 TEM procedures performed over the previous year, 206 were referred cases. Eighty-five per cent of consultants considered TEM a necessary technique for optimum management of rectal lesions. Although 61% of consultants considered endoanal excision optimal for low benign rectal tumours, 58% said TEM was optimal for midrectal lesions and between 30% and 55% for high rectal lesions depending if the tumour position was anterior or posterior, respectively. One-third of consultants would perform TEM for a low T1 rectal carcinoma although half would proceed to anterior resection. DISCUSSION: TEM is considered to have a significant role in the optimal management of rectal lesions. The presence of the technique in a limited number of hospitals does appear to provide adequate resources although audit should continue to be centralized.     

经肛门内镜微创手术治疗直肠上皮内瘤变和早期直肠癌

目的探讨经肛门内镜微创手术（TEM）治疗直肠上皮内瘤变（IN）和早期直肠癌的临床价值。方法选择15例直肠肿瘤患者采用TEM行局部切除术。根据活检病理结合直肠腔内超声检查（EUS）术前诊断低级别IN8例，高级别IN4例，早期直肠癌3例。肿瘤距肛缘的距离4—15（平均7．2）cm，肿瘤直径1—4（平均1．8）cm，肿瘤占据肠腔周径比例10％～40％（平均20％）。结果15例直肠肿瘤均获完整切除（黏膜下切除5例，全层切除10例），各切缘均阴性。手术时间为40．90（平均57）min；术中出血量为10-60（平均35）ml。术后住院时间为2-9（平均4．5）d。术后病理确诊：直肠低级别IN5例，高级别IN6例，早期黏膜下浸润癌（pT1期）和进展期癌（pT2期）各2例。术前EUS评估肿瘤浸润肠壁深度的准确率为86．7％（13／15）。15例术后随访2．10（平均6）个月，肿瘤无局部复发。结论TEM微创、显露良好、切除精确、能获取高质量的肿瘤标本用于准确的病理分期，是治疗直肠IN和早期直肠癌的理想术式。术前EUS检查对TEM病例的选择十分重要。     

手术方式对肛缘距离≤8.0 cm中老年T1期直肠癌患者治疗效果和安全性的影响

目的探讨不同手术方式对肛缘距离(DAV)≤8.0 cm中老年T1期直肠癌患者治疗效果和安全性的影响。 方法回顾性分析2012年1月至2014年1月76例距肛缘距离(DAV)≤8.0 cm中老年直肠癌T1期患者的资料,根据不同手术方式分为局部切除组(39例,行经肛门局部切除术)和根治切除组(37例,行经腹根治性切除术)。采用SPSS 22.0统计软件进行分析,术中术后相关指标以( ±s)表示,采用独立t检验;术后并发症发生率及死亡率组间对比采用χ²检验。P<0.05为差异有统计学意义。 结果与根治切除组比,局部切除组患者手术时间、术中出血量显著减少,术后首次排气时间、首次进食时间、留置导尿管时间、住院时间和术后并发症发生率显著降低,尤其是肺部感染发生率;术后3年内肛门失禁、性功能障碍发生率显著降低,差异均具有统计学意义(P<0.05)。两组患者3年内肿瘤复发、转移发生率及生存率相比,差异均无统计学意义。 结论经肛门局部切除术与经腹根治性切除术治疗DAV≤8.0 cm中老年T1期直肠癌患者的临床效果及3年预后相近,但前者术后并发症发生率显著低于后者,且在排便功能及性功能保护方面显著优于后者。     

经肛门内镜微创手术与传统经肛门局切术治疗早期直肠肿瘤的疗效对比

目的 对比经肛门内镜微创手术(TEM)与传统经肛门局切术(TAE)治疗早期直肠肿瘤的应用指征、安全性、疗效.方法 回顾性分析上海交通大学医学院附属瑞金医院普外科2003年1月- 2006年7月完成的76例传统经肛门局切术及2006年9月- 2010年2月完成的53例经肛门内镜微创手术的临床资料.结果 两组患者性别、年龄...     

直肠癌经肛门内镜显微手术疗效及复发危险因素分析

目的 分析直肠癌经肛门内镜显微手术（TEM）疗效及复发危险因素,以探讨直肠癌TEM适应证.方法 对2006年6月至2009年6月间山东省千佛山医院胃肠外科收治的60例行TEM的直肠癌患者的临床资料进行回顾性分析.结果 本组直肠癌pTis期12例,pT1期38例 pT2期10例.全部病灶均一次性全层整块切除,标本切缘均阴性.手术时间30～190（65.0±36.5）min,术中失血量9～75（10.5±5.8）ml,住院时间3～9（4.5±2.7）d,无手术死亡和严重并发症出现.随访时间12～48（平均28.5）个月,无一例死亡.pTis患者均未现复发 38例pT1期患者中1例（2.6%）出现局部复发 10例pT2期患者中有4例（40.0%）出现局部复发,显著高于pT1期患者（P＜0.05）.肿瘤直径大于3 cm的21例患者中有4例复发,显著高于肿瘤直径小于3 cm者（1/39,P＜0.05）.多因素复发危险因素分析证实,浸润深度和肿瘤大小是TEM术后复发的独立风险因素.结论 对pTis、pT1期及肿瘤小于3 cm的早期直肠癌患者,TEM安全有效,值得推广.