经肛门内镜显微手术治疗直肠肿物41例临床观察

Transanal Endoscopic Microsurgery in the Treatment of Rectal Neoplasm in 41 Cases：Clinical Observation

为探讨经肛门内镜显微手术（TEM）治疗直肠肿物的手术技巧，回顾性分析41例TEM患者临床资料。距肿瘤边缘5～10mm行全层或黏膜下切除，切除后缝合关闭创面，标本送病理检查。结果显示，直肠腺瘤性息肉9例、直肠腺瘤23例、直肠间质肿瘤4例、直肠类癌2例及晚期直肠癌3例。手术时间平均68（40～200）min，术中平均出血量30（10～50）ml，术后住院天数平均5（2～7）d。术后并发出血2例，尿潴留1例，肛门括约肌功能异常1例。术后随访直肠癌晚期3例中1例于术后10个月复发，复发率为2．4％。结果表明，TEM提供了一种安全、有效的治疗良性及早期恶性直肠肿瘤的方法，具有手术损伤小、出血少、疗效好和恢复快等优点，具有良好的临床应用前景。

In order to search for the skill in transanal endoscopic microsurgery（TEM） for rectal tumor au- thors retrospectively analyzed the clinical data of 41 cases subjected to TEM, i.e the status on the full- thickness or submucous resection of tumor 5-10 cm far from edge, afterward sutured and closed, sampled specimen were taken to be pathyologically examined.As results,these rectal tumor included neoplastic pol- yp in 9 cases,adenoma in 23 cases,stromal tumor in 4 cases,carcinoid in 2 cases,and rectal carcinoma in 3 cases;the operative time was 40-200 rain（averaged 68 min）, the intraoperative bleeding volume was 1-50 ml （averaged 30 ml）, the postoperative hospitalization was 2-7 d （averaged 5 d）, postoperative complicated bleeding occured in 2 cases,urosthesis in 1 case,anal sphincter dysfunction in 1 case;l of the followed up 3 cases after operation of advanced carcinoma recurrented 10 months after operation（its recurrence rate, 2.4%）.Results show that TEM is really a safe and effective therapy for early metastasis and benign rectal tumor,has such merits as less operative injuries,little bleeding volume, better effect and faster recovery, etc,thus has good clinical application prospect.