经肛门显微内镜的手术治疗直肠类癌临床研究(附3例病例报告)

Treatment with Rectal Carcinoid by Transanal Endoscopic Microsurgery(TEM):Report of 3 cases

目的:探讨经肛门内镜显微手术治疗直肠类癌的疗效。方法:选择3例直肠类癌患者,全麻下根据肿瘤位置选择合适的体位,经肛门插入特殊的TEM直肠镜,保持CO2充气状态,在立体视镜和腔镜系统下,采用针形电刀将直肠类癌完整切除(黏膜下或全层切除),直肠创面行连续缝合。结果:3例直肠肿瘤均获完整切除,切缘均阴性。随访8～16个月,平均11个月,肿瘤无复发。结论:TEM是治疗直肠类癌的一种安全、有效的微创手术方法。

Objective：To investigate outcomes of transanal endoscopic microsurgery（TEM）for the treatment with rectal carcinoid.Methods：3 patients with rectal carcinoid underwent TEM.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO2 insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments,the tumor was completely resected（submucosal or full-thickness excision）using a needle diathermy.The operative wound was closed with intra-lumen continuous sutured.Results：The rectal tumor was completely removed with negative resection margins in all the 3 patients.Follow-up checkups in the 3 patients for 8~16 months（mean 11 months） revealed local recurrence.Conclusion：TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal carcinoid.