经肛门内镜显微手术在直肠肿瘤局部切除术中的应用

Clinical Use of Transanal Endoscopic Microsurgery for Local Excision of Rectal Tumors

目的初步评价经肛门内镜显微手术（transanal endoscopic microsurgery，TEM）在直肠肿瘤局部切除术中的应用。方法2006年4月至9月对8例直肠肿瘤患者采用TEM行局部切除术。术前根据直肠腔内超声肿瘤分期：uTo期6例，uTis期和uT1期各1例。肿瘤距肛缘距离平均7（4～9）cm；肿瘤直径平均1．5（1～2．5）cm；肿瘤占据肠腔周径比例平均20％（10％～30％）。结果8例直肠肿瘤均获完整切除（粘膜下切除3例，全层切除5例），各切缘均阴性。手术时间平均50（40～60）min；术中平均出血量30（10～50）ml。术后住院天数平均5（2～7）d。无一例出现手术并发症。术后病理分期：pT0期5例，pTis期、pT1期和pT2期各1例。8例术后随访平均3（1～5）个月，肿瘤无局部复发。结论TEM显露良好、切除精确，手术安全、创伤小，经严格选择病例可用于良性直肠肿瘤和早期直肠癌的彻底切除。

Objective To evaluate the clinical use of transanal endoscopic microsurgery （TEM） for local excision of rectal tumors. Methods From April to September 2006, 8 patients with rectal tumor underwent local excision by TEM. The preoperative staging by transanal ultrasonography： uT0 in 6, uTis in 1 and uT1 in 1. The tumors were located superior to the anal averge in a distance of 7 cm （4 -9 cm） . The median tumor size was 1.5 cm 1 -2.5 cm）. The median proportion of the circumference of bowel involved by tumor was 20% （ 10% - 30% ）. Results All the 8 rectal tumors achieved complete excision （submucosal excision in 3, full-thickness excision m 5 ）, and all the resection margins were clear. The median operating time was 50 minutes （40 -60 minutes）. The median blood loss was 30 ml （ 10 -50 ml）. There was no operative complication. The tumors were pathologically staged as pT0 in 5, pTis in 1, pT1 in 1, pT2 in 1. The median follow-up period of 8 patients was 3 months （ 1 -5 months）. There was no local recurrence. Conclutions TEM is a safe, effective and minimally invasive surgical technique leading to excellent exposure and accurate excision. In carefully selected patients, TEM can be used for local complete excision of benign rectal adenoma and early rectal carcinoma.