TEM治疗直肠肿瘤19例体会

Treatment of rectal cancer by transanal endoscopic microsurgery:experience with 19 patients

目的总结经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤的手术经验及技巧。方法 2011年5月~2013年12月,对19例直肠肿瘤行TEM治疗,选择适当体位使直肠肿瘤位于TEM器械视野下半区,距肿瘤边缘至少0.5~1 cm行肠壁全层或粘膜下切除,创面连续缝合关闭。结果 19例直肠病变均获得完整切除,2例合并横结肠癌同时行横结肠癌根治术,平均手术时间(55.8±37.7)分钟,术后平均住院时间(8.5±3.3)天。术后2例患者出现肛门出血,1例绒毛状管状腺瘤复发,其余病例均无复发。结论 TEM手术体位选择非常重要,病变切除及创面缝合过程应遵循一定的手术方法,不同病变选择不同的切除方式;TEM存在学习曲线,初学者应选择手术相对简单的病例进行经验积累。

Objective To summarize our experience in transanal endoscopic microsurgery ( TEM) for rectal tumors.Methods Between May 2011 and December 2013,TEM was performed in 19 patients with rectal tumor in our hospital .The Patients were positioned properly so that the tumor was directly under the surgical field through transanal endoscope .The tumor was removed with 0.5 to 1.0cm adjacent tissues by endoscopic full-thickness resection or the submucosal excision .Afterwards,the resection bed for lesion was closed using a running suture .Results All 19 patients,the rectal tumor was removed completely ,2 patients of them with synchronous transverse colon cancer underwent radical resection of colon at the same time .The mean operation time was(55.8 ±37.7)minutes in our cases.The mean postoperative hospital stay was (8.5 ±3.3)days.Two patients developed anal hemorrhage after operation .We detected recurrence in 1 of the 19 patients with rectal villous tubular adenoma .Conclusions The surgical position is very important for the TEM,a certain surgical procedure is requested during resection of the tumor and suture of wound ,the choice of resectable area is different for the tumors .There is learning curve effect for TEM ,and the beginners should choose some simple cases for the accumulation of experience .