经肛门内窥镜下微创治疗直肠肿瘤40例初步经验

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临床效果.方法 分析2005年5月至2007年4月40例TEM手术的临床效果,结果 40例肿瘤直径中位值2.3 cm,肿瘤下缘距齿状线距离为(8.2±3.2)cm,肿瘤侵犯直肠周径范围为(32.3±18.5)%.平均手术时间为(90±43)min.平均住院4.8 d.无围手术期死亡.切缘瘤细胞均为阴性.病理示直肠绒毛状腺瘤24例、直肠腺癌10例、直肠类癌6例,10例腺癌中pTis2例,PT16例和pT22例.平均随访11个月,所有病例无局部复发.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期直肠癌的治愈性手术,也可作为pT2直肠癌的姑息性治疗手段.

Transanal endoscopic microsurgery for excision of rectal tumors

0bjective To assess the clinical effects of transanal endoscopic microsurgery(TEM)in the surgical treatment of rectal sessile adenoma and early rec-tal carcinoma.Methods From May 2005 to April 2006,forty consecutive patients with rectal sessile,adenoma or early rectal carcinoma underwent TEM,and the clinical data of these patients were analyzed retrospectively.Results The median diameter of tumors was 2.3 cm and the mean distance of the tumors from the anal verge was (8.2±3.2)cm.These tumors invaded(32.3±18.5)%of the circumference on av-erage.In these patients the mean operating time,was (90±43) minutes and the mean hospital stay,was 4.8 days.There,was no periopreative death.Complications included urinary retention and temporary flatus incontinence.The resection margin was clear in all patients.Pathological examination revealed 24 patients had rectal vollous adenoma,6 rectal carcinoid,and 10 rectal adenocarcinoma.Among these rectal adenocarcino-mas,2 belonged to pTis,6 to pT1 and 2 to pT2.Transrectal ultrasonography,was per-formed in the preoperative staging of rectal cancer(85 7%).The median follow up period,was 11 months and no local recurrence occurred.Conclusions Being safe,effective and minimally invasive,TEM can decrease the length of hospital stay and preserve the anal sphincter.TEM is not only a curative treatment for rectal sessile ade-noma and early rectal carcinoma(T1)but also a good palliative treatment for T2 tumor.