经肛手套通路联合结肠镜微创手术治疗直肠肿瘤

Transanal endoscopic microsurgery by transanal glove port combined with colonoscopy for ;excision of rectal tumors

目的：探讨经肛手套通路联合结肠镜微创手术治疗直肠肿瘤的可行性及疗效。方法杭州市第三人民医院肛肠外科自2012年10月至2013年3月，选择经评估适合行局部切除的直肠肿瘤患者8例，使用经肛手套通路联合结肠镜微创手术治疗。经肛手套通路的建立：将手套袖口连同扩肛器缝合固定于肛周，再将手套5指经由透明肛门镜翻转出肛门，将超声刀、无损伤肠钳和肠镜镜头分别从3个指套伸入并结扎固定。结果8例患者均成功完成肿瘤切除手术，制作手套入路装置平均耗时12．5（10．0～15．0） min，平均手术时间55．6（30．0～110．0） min，平均住院时间为5．0（3．0～8．0） d，术后病理提示绒毛状腺瘤3例，管状腺瘤2瘤，管状绒毛状腺瘤2例，锯齿状腺瘤1例，其中2例伴低级别上皮内瘤变，1例高级别上皮内瘤变，所有肿瘤组织标本边缘及基底部均为阴性。术后2例患者少量便血，随访1～5（中位3．1）月，无肿瘤复发。结论采用经肛手套通路联合结肠镜微创手术治疗直肠早期肿瘤具有简单和安全的特点，具有一定的应用价值。

Obejective To evaluate the feasibility and efficacy of transanal endoscopic microsurgery （TEM） by transanal glove port combined with colonoscopy for excision of rectal tumors. Methods Eight patients with rectal cancer eligible for local resection were chosen to receive a procedure performed via a “glove TEM port” from October 2012 to March 2013. This device was constructed on-table using a circular anal dilator（CAD）,standard surgical glove,colonoscopy instruments and straight laparoscopic instruments. Results Procedures of all the patients were completed successfully by glove TEM. The median （range） diameter of tumor was 2.6 （1.5-3.5） cm,the median （range） operative time was 55.6 （30-110） min. Postoperative pathology included villous adenomas （n=3 ） , tubular adenomas （ n=2 ） , tubulovillous adenomas （ n=2 ） , serrated adenoma （ n=1 ） , low-grade intraepithelial neoplasia （ n=2 ） , and high-grade intraepithelial neoplasia （ n=1 ） . All resection margins were negative. Two patients presented with postoperative minor bleeding. There were no serious intraoperative complications. No cancer recurrence was found during a follow-up of 1-5 （median 3.1） months. Conclusion Transanal endoscopic microsurgery by transanal glove port combined with colonoscopy in the treatment of early rectal cancer is easy and safe.