TEM技术在直肠手术中应用的实验研究

Application of TEM Technique in Rectal Operation：An Experimental Study

为了研究经肛门内镜微创手术（TEM）的临床实用性、可靠性和手术技巧，对40例离体的动物标本进行了实验研究。将40例牛的结肠用TEM手术模型支架固定在支架台上制成一个动物的直肠模型，用TEM手术器械和电外科手术器械操作。对每例模型分别做直肠黏膜下切除和全层切除术，切除范围1／3或1／2肠周，同时对模拟出血的血管进行止血，最后将创面用连续缝合的方法关闭。用加压泵向肠系膜血管注血检查术中止血的效果，高频单极电刀的止血效果达95％。术后行充水实验及缝合张力检查，20例1／3肠周切除模型，均无漏水和缝线张力过松及切口对合不好的现象。20例1／2肠周切除的模型，黏膜下切除有2例缝合线张力过紧，肠腔相对变小，但无充水实验漏水现象。全层切除模型有2例充水实验阳性。结果表明，TEM手术是一种安全性高、创伤小，具有可操作性的微创手术，术中要注意缝合的技巧、左右侧肠壁的缝合方法和暴露的技巧，过长的创面最好做多个连续缝合，高频电刀止血效果可靠。

The objective of this experimental study was to explore the clinical practice, feasibility of transanal endoscopic microsurgery（TEM） and its procedure skill. The colon of 40 oxen （or cow） were fixed on a frame-platform with the help of the operation model-frame of TEM so as to establish animal rectal model, then operated on by using TEM operative and electro-surgical appliances：to perform the rectal submucous excision and full-thickness excision, range of excision wasl/3 or 1/2 intestinal circumference; at same time to make the simulantly bleeding vessels hemostasia; finally, to close the wound with the continued suture method;with the help of compression pump to inject blood into mesentery checks on the effects of operative hemostasia,the hemostasia effects of high-frequency mono-polar electrotome up to 95%. Postoperative filling water experiment and suture tension examination showed that in 20 cases of 1/3 intestinal circumference models all were not any phenomena such as leakage of water, too loose suture-tension and not same identical point of wound edge;as to in 20 cases of 1/2 intestinal circumference models,2 cases of submucous excision,suture tension was too tight so that intestinal lumen becoming relative stricture, but without the leakage of water;2 cases of full-thickness excision,their filling water experiment showed positive results. In a word,above-mentioned results show that TEM is microsurgery procedure with high safety,less trauma,and has operatable feature,but during operation it is noticed such as suture skill, suture methods of right or left intestinal wall,as well exposure technic;for too long wound it would be best making multi-continued suture;high-frequency electrotome has better hemostasia effects.