经肛门内镜显微外科手术（TEM）治疗直肠少见肿瘤

目的探讨经肛门内镜显微外科手术（TEM）在直肠少见肿瘤治疗中的应用。 方法2006年4月至2018年5月，北京协和医院共收治157例直肠少见肿瘤患者。收集临床资料，建立回顾性准确数据库。其中男性89例,女性68例。平均肿瘤直径（1.2±0.7）cm（0.2~5.3 cm），距肛缘平均距离（6.6±2.3）cm（2~12 cm）。分析人口学特征、手术细节、肿瘤特点、并发症和随访资料。 结果所有患者均获得全层完全切除，切缘阴性。术中并发症3例，术后并发症21例。病理组织学结果报告神经内分泌肿瘤（NETs）114例；胃肠道间质肿瘤（GISTs）35例，黑色素瘤、淋巴瘤和平滑肌瘤各2例；脂肪瘤和鳞癌各1例。145例患者平均随访（56.25±32.13）个月（19~144个月），2例死亡，1例局部复发，1例出现淋巴结转移。1例在术后1个月出现直肠阴道瘘。其余患者无局部复发、转移、大便失禁。神经内分泌瘤亚组分析中，初次手术组与内镜术后补救组之间比较，手术时长、术中出血量、术后住院天数等方面差异无统计学意义。在间质瘤亚组分析中，新辅助治疗组与直接手术组之间，同样在手术时长、术中出血量、术后住院天数等方面差异无统计学意义。 结论TEM是治疗直肠少见肿瘤的可靠方法。并发症发生率低，疗效满意。

Transanal endoscopic microsurgery (TEM) for rare rectal tumors

ObjectiveThe purpose of this article is to discuss the application of TEM in the treatment of rare rectal tumors. MethodsFrom April 2006 to May 2018, 157 patients with rare rectal tumors were treated in Peking Union Medical College Hospital. To collect clinical data and establish a retrospective and accurate database. There were 89 males and 68 females. The average diameter of the tumors was (1.2±0.7) cm, (0.2~5.3 cm) and the average distance from the anal margin was (6.6±2.3) cm, (2~12 cm). The demographic characteristics, surgical details, tumor characteristics, complications and follow-up data were analyzed. ResultsAll patients were completely resected with negative incision margin. There were 3 intraoperative complications and 21 post-operative complications. Histopathological findings were reported in 114 cases of neuroendocrine tumors (NETs), thirty-five cases of gastrointestinal stromal tumors (GISTs), two cases of melanoma, two cases of lymphoma and 2 cases of leiomyoma, one case of lipoma and 1 case of squamous cell carcinoma. 145 patients were followed up for (56.25±32.13) months (19~144 months). Two patients died, one had local recurrence and one had lymph node metastasis. One case developed rectovaginal fistula one month after operation. No local recurrence, metastasis or fecal incontinence occurred in the other patients. In the analysis of neuroendocrine tumor subgroup, there was no significant difference in operation time, intraoperative bleeding and postoperative hospital stay between first operation group and the second surgery failed group. In gastrointestinal stromal tumor subgroup, there was also no significant difference between the neoadjuvant therapy group and without neoadjuvant therapy group in operation time, intraoperative bleeding and postoperative hospital stay. ConclusionTEM is a reliable `treatmentfor rare rectal tumors. The incidence of complications is low and the curative effect is satisfactory.