经肛门内窥镜下微创外科技术治疗直肠肿瘤120例临床经验

目的评价经肛门内窥镜微创外科技术（TEM）治疗直肠宽基腺瘤和早期直肠癌的应用效果。方法分析评价2005年5月至2009年2月120例TEM手术的临床资料。结果本组患者肿瘤直径中位值2．5cm，肿瘤下缘距齿状线距离（8．4±3．2）cm，肿瘤侵犯直肠周径范围（32．3±18．5）％。平均手术时间（80±45）min。平均住院日5．2d。无围手术期死亡。手术并发症有直肠穿孔、创面裂开和短暂性大便失禁。病理示直肠腺瘤72例、直肠腺癌34例、直肠类癌12例、直肠间质瘤2例。34例腺癌中pTis9例，pT119例和pT26例。直肠癌术前腔内超声分期符合率为83．3％。平均随访21个月，有2例患者有局部复发。结论TEM手术创伤小、痛苦少、住院时间短、保留肛门括约肌；既可作为直肠宽基腺瘤和pT1期直肠癌的治愈性手术，也可作为pT2直肠癌的姑息性治疗手段。

Clinical experience of transanal endoscopic microsurgery in the treatment for 120 patients with rectal tumors

Objective To evaluate the curative effect of transanal endoscopic microsurgery in treatment for thick-pedicel rectoadenoma and early recal cancer. Methods The data about 120 patients undergoing transanal endoscopic microsurgery during the period from May 2005 to February 2009 in our hospital were reviewed. Results Transanal endoscopic microsurgery was successfully performed in all the patients without procedures converted to laparotomy. The median tumor diameter was 2.5 centimeter and the distance between tumor lower edge and linea dentata was 8.4±3.2 centimeter with an tumor-involved 32.3%±18.5% of rectal circumference. The average operation time and hospital stay was 80 minutes and 5.2 days respectively.The accuracy rate of preoperative endorectal ultrasound stage for rectal cancer was 83.3%. There was no perioperative mortality while two local recurrence were found through the average follow-up of 21 months. The few complications included rectal perforation, wound dehiscence and temporary flatus incontinence. Conclusion Transanal endoscopic microsurgery is a minimally invasive and anal-sphincter-preserving surgery. Transanal endoscopic microsurgery can be a radical operation for rectal adenoma with thick pedicel and pT1 rectal cancer as well as a palliative surgery for pT2 recatal cancer.