经肛内镜微创外科治疗早期直肠癌的价值

目的:评价经肛内镜微创外科技术(transanal endoscopic microsurgery,TEM)治疗早期直肠癌的应用效果。方法:分析评价我院2005年5月至2009年5月所治疗的84例TEM手术的临床资料。结果:本研究84例病人的肿瘤直径中位值为2.1 cm,肿瘤下缘距齿状线平均距离(8.3±2.2)cm,肿瘤侵犯直肠周径范围(33.2±17.5)%。平均手术时间(70±43)min。平均住院日期6.8 d。无一例病人发生围手术期死亡,术后部分病人有短暂性大便失禁。所有病人的肿瘤切缘皆无瘤细胞残留。术后病理证实,85例中pT060例,pT119例,pT25例。直肠癌术前腔内超声分期符合率达86.9%。平均随访26个月,2例病人出现局部复发。结论:TEM手术创伤小、保留肛门括约肌、缩短住院时间;既可作为直肠宽基腺瘤和pT1期直肠癌的根治性手术,也可作为pT2直肠癌的姑息性治疗手段。

Experince of Transanal Endoscopic Microsurgery (TEM) in the Treatment for Early Rectal Cancer

Objective To investigate the therapeutic effects of transanal endoscopic microsurgery（TEM） for early rectal carcinoma.Methods The clinical data of 84 patients with early rectal carcinomas admitted between May 2005 and May 2009,were analyzed retrospectively.Results The mean diameter of the rectal lesions was 2.1 cm.The average distance between the distaledge of the lesion and the dentate line was（8.3 ＋/-2.8） cm.The average circumferential invasion of the rectum was（33.2＋/-17.5）%.The average operating time was（70 ＋/-43） min.The average postoperative hospital stay was 6.8 days.No perioperative mortality occurred.The main postoperative complication was temporary anal incontinence.The surgical margins of all specimens were negative.The postoperative histopathology identified 60 cases of to be of stage T0,19 cases of T1 and 5 cases of T2.The Accuracy of preoperative endorectal ultrasonography in staging rectal cancers was 86.9%.All the patients were followed-up during a mean period of 26 months,and local recurrence was discovered in 2 patients.Conclusions As a type of minimally invasive surgery with better analsphincter reservation and shorter hospital stay,TEM can be used as a curative measure for wide-pedunculated adenomas and pT1 cancers,and palliative therapy for pT2 rectal cancers.