经肛门内镜微创手术的应用现状和进展

Application and prospects of transanal endoscopic microsurgery

经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)是通过肛门入径结合直肠内镜技术、腹腔镜技术、微创技术优点为一体的新型手术方式,该手术方式能放大6倍手术视野,使得术者能更加清晰准确地切除中上段直肠病变,克服了肛门括约肌和骨盆骨性界限切除的局限性,适用于直肠腺瘤、直肠息肉等良性病变,以及无淋巴结转移的cT1直肠癌,对于更高级别直肠癌的治疗仍存在一定的争议。新辅助放化疗联合TEM治疗直肠癌在国内外正积极的开展,并取得了不错的效果,本文对TEM的手术器械、方法、适应证、术前评估、进展以及争议等进行综述。

Transanal endoscopic microsurgery(TEM)is a new surgical method which combines the advantages of anal approach,rectal endoscopic technology,laparoscopic technology and minimally invasive technology.This surgical method can enlarge the operative field of vision by six times,help the operator make more clear and accurate resection of upper and middle rectal lesions,overcome the limitations of resection of anal sphincter and pelvic bone boundary,and it is suitable for rectal adenoma,rectal polyp,etc.TEM is suitable for ct1 rectal cancer without lymph node metastasis,but there is still some controversy about the treatment of higher grade rectal cancer.Neoadjuvant radiotherapy and chemotherapy combined with TEM in the treatment of rectal cancer is being actively carried out at home and abroad,and good results have been achieved.This paper reviews the surgical instruments,methods,indications,preoperative evaluation,latest progress and controversy of TEM.