经肛门内镜微创手术治疗直肠肿瘤(附74例报告)

Transanal endoscopic microsurgery for rectal tumors: 74 cases report

目的：探讨经肛门内镜微创手术（transanal endoscopic microsurgery,TEM）治疗直肠腺瘤和早期直肠癌的临床价值和安全性。方法：回顾性分析我院2011年1月至2014年1月74例直肠腺瘤和早期直肠癌病人行TEM的治疗情况并总结相关经验。结果：所有74例病人均成功施行TEM,术前均行肠镜活检和经直肠内镜超声检查。术后病理检查结果示：直肠腺瘤46例、直肠高级别上皮内瘤变10例、直肠神经内分泌瘤G1期5例、直肠癌13例。13例直肠癌病人中7例T0期,5例T1期,1例T2期。TEM时间（58.3±27.2）min,术中出血（10.4±5.6）m L,术后住院1~4 d,无严重并发症。1例T2期,1例T1期侵及黏膜下层外1/3,予以再入院行腹腔镜直肠癌前切除术。所有病人均得到随访,平均随访时间（15±8）个月,2例直肠绒毛状腺瘤病人术后复发,均通过再次TEM完整切除。所有早期直肠癌和直肠神经内分泌瘤病人术后随访均未发现肿瘤复发或转移。结论：TEM创伤小,病人恢复快,治疗直肠腺瘤和部分经过选择的早期直肠癌病人安全可靠。完善的术前评估和术后随访十分重要。

Objective To evaluate the outcome and safety of transanal endoscopic microsurgery （TEM） for rectal ade- noma and early rectal cancer. Methods Data of 74 patients undergoing TEM for rectal adenoma and early rectal cancer in Renji Hospital between January 2011 and January 2014 were reviewed. Results All 74 patients had successful TEM. The preoperative diagnosis was done with biopsy and endoanal uhrasonography. It was shown with postoperative pathology as rectal adenomas （46）, high grade intraepithelial neoplasia （10）, neuroendocrine tumor of rectum （5）, rectal cancer To （7）, rectal cancer T1（5） and rectal cancer T2 （1）. Mean operation time was （58.3±27.2） min and mean blood loss （10.4±5.6） mL. Postoperative stay was 1-4 d and there was no severe complications. Follow-up was（15±8） months for all patients. Two cas- es recurred recal adenomas with second successful TEM. No recurrence or metastasis was observed in early rectal carcino- ma or neuroendocrine tumor of rectum. Conclusions TEM is minimally invasive treatment of rectal adenoma and some se- lected early rectal cancer. Preoperative evaluation and postoperative followed-up are very important for TEM.