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。

Treatment of rectal villous adenoma and early rectal carcinoma by transanal endoscopic microsurgery:Report of 31 cases

Objective To investigate outcomes of transanal endoscopic microsurgery(TEM) for the treatment of rectal villous adenoma and early-stage rectal carcinoma.Methods A series of 31 patients with rectal tumors underwent TEM from November 1995 to December 2003.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO_2 insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments,the tumor was completely resected(submucosal or full-thickness excision) using a needle diathermy or a 5-mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.Results The rectal tumor was completely removed with negative resection margins in all the 31 patients.The operating time was 45~220 min(mean,95 min) and the intraoperative blood loss was 0~180 ml(mean,40 ml).Complications included temporary flatus incontinence in 2 patients,acute retention of urine in 1 patient,exacerbation of chronic obstructive airway disease in 1,and secondary hemorrhage following Aspirin taking in 1.The postoperative pathological stages were pT_0 in 16 patients,pT_(is) in 2 patients,pT_1 in 7,pT_2 in 3,and pT_3 in 3.Follow-up checkups in the 31 patients for 2~92 months(mean,23 months) revealed no local recurrence.Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal villous adenoma and early rectal carcinoma.