经肛门内镜微创手术治疗直肠肿瘤研究进展

Research progress of transanal endoscopic microsurgery for rectal tumors

目的总结目前经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)在治疗直肠肿瘤的研究进展。方法收集经肛门内镜治疗直肠肿瘤的文献并予以综述。结果TEM是局部切除手术方式中的一种,为腹腔镜和内镜相结合的微创手术,TEM设备主要由特殊的直肠镜镜头和高压气腹机组成。对病变部位进行全层切除后,在内镜直视下对缺损部位进行缝合,从而避免了根治性手术带来的严重术后并发症。TEM适用于直肠腺瘤、直肠息肉等良性病变和无淋巴结转移的T1期直肠癌,对于更高级别的直肠癌的治疗仍存在一定的争议,新辅助放化疗联合TEM治疗直肠癌在积极的开展当中。结论TEM对部分直肠肿瘤是一种安全有效的手术方式,具有围手术期并发症发生率低、术后恢复快和复发率低的特点。

Objective To summarize the research progress of transanal endoscopic microsurgery in the treatment of rectal tumors.Method The literatures on transanal endoscopic treatment of rectal tumors was collected and reviewed.Results Transanal endoscopic microsurgery was one of the local resection methods.It was a minimally invasive surgery combining laparoscopy and endoscopy.Transanal endoscopic microsurgery equipment was mainly composed of special rectal mirror lens and high-pressure pneumoperitoneum machine.After full-thickness resection of the lesion,the defect was sutured under endoscopy,so as to avoid serious postoperative complications caused by radical surgery.Transanal endoscopic microsurgery was suitable for T1 stage rectal cancer with benign lesions such as rectal adenoma and rectal polyps and no lymph node metastasis.There was still some controversy about the treatment of highergrade rectal cancer.Neoadjuvant radiotherapy and chemotherapy combined with transanal endoscopic microsurgery is being actively carried out in the treatment of rectal cancer.Conclusions Transanal endoscopic microsurgery is a safe and effective method for some rectal tumors.It has the characteristics of low perioperative complication rate,fast postoperative recovery and low recurrence rate.