经肛门内镜微创手术治疗直肠肿瘤的临床应用(附12例报告)

Clinical application of transanal endoscopic microsurgery for rectal tumor(a report of 12 cases)

目的 观察探讨经肛门内镜微创手术（TEM）在直肠肿瘤局部切除术中的应用价值。方法 2013年4月-2014年9月对12例直肠肿瘤患者采用TEM局部切除术。术前根据内镜腔内超声肿瘤侵犯不超过肌层。肿瘤下缘距离肛缘9 cm（5~12 cm）,肿瘤占据肠腔周径比例最大小于1/3圈。结果 全组平均手术时间80.3 min（55~138 min）,术中平均出血量27.5 ml（10~40 ml）,术后平均住院天数3.8 d（2~6 d）,肿瘤直径2.4 cm（1~4cm）,所有肿瘤获整块切除,切缘均阴性。术后病理显示,管状腺瘤4例,重度不典型增生1例,绒毛状腺瘤3例,管状腺瘤癌变1例,类癌1例,早期腺癌2例。其中Tis期（原位癌）1例,T1期3例。所有病例无术后并发症。术后随访4周~1年,未见肿瘤局部复发及转移。结论 TEM显露好且切除精确完整,手术安全、创伤小且恢复快,可用于良性、低度恶性直肠肿瘤和早期直肠癌的完全切除。

[ Objective ] To explore the application value of the transanaI endoscopic microsurgery （TEM） in the local excision of rectal tumors. [ Methods ] From April 2013 to September 2014, 12 patients with rectal tumor were treated with TEM local excision. Based on the diagnosis of preoperative endoscopic endoluminal ultrasound, the in- vasion was not more than muscle layer. The distance between the lower margin of the tumor and the anal verge was 9 cm （5-12 cm）, the maximum ratio of tumor occuping the circumference of the rectum was less than 1/3 ring. IRe- suits] The average operation time was 80.3 rain （55-138 min）, the mean intraoperative blood loss was 27.5 ml（10- 40 ml）, the average postoperative hospital stay was 3.8 d （2-6 d）. Tumor diameter was 2.4 cm （1-4 cm）, all the tu- mors were completely resected, the resection margins were negative. The postoperative pathological report displayed 4 cases of tubular adenoma, l case of severe atypical hyperplasia, 3 cases of villous adenoma, 1 case of tubular ade- noma canceration, 1 case of earcinoid, 2 cases of early adenocarcinoma. Among them there were 1 patient with stage Tis, 3 patients with stage T1. All cases had no postoperative complications. Patients were followed up for 4 weeks to 1 year, no local recurrence and metastasis was found. [ Conclusion ] TEM showes some advantages of good exposure, accurate and complete resection, operation safety, small trauma, quick recovery, and can be used for complete excision of benign, low-grade malignant rectal tumors and early rectal cancer.