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.

Transanal endoscopic microsurgery for the treatment of localized rectal neoplasms