Local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom

BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms

Transanal surgery has and continues to be well accepted for local excision of benign rectal disease not amenable to endoscopic resection. More recently, there has been increasing interest in applying transanal surgery to local resection of early malignant disease. In addition, some groups have started utilizing a transanal route in order to accomplish total mesorectal excision(TME) for more advanced rectal malignancies. We aim to review the role of various transanal and endoscopic techniquesin the local resection of benign and malignant rectal disease based on published trial data. Preliminary data on the use of transanal platforms to accomplish TME will also be highlighted. For endoscopically unresectable rectal adenomas, transanal surgery remains a widely accepted method with minimal morbidity that avoids the downsides of a major abdomino-pelvic operation. Transanal endoscopic microsurgery and transanal minimally invasive surgery offer improved visualization and magnification, allowing for finer and more precise dissection of more proximal and larger rectal lesions without compromising patient outcome. Some studies have demonstrated efficacy in utilizing transanal platforms in the surgical management of early rectal malignancies in selected patients. There is an overall higher recurrence rate with transanal surgery with the concern that neither chemoradiation nor salvage surgery may compensate for previous approach and correct the inferior outcome. Application of transanal platforms to accomplish transanal TME in a natural orifice fashion are still in their infancy and currently should be considered experimental. The current data demonstrate that transanal surgery remains an excellent option in the surgical management of benign rectal disease. However, care should be used when selecting patients with malignant disease. The application of transanal platforms continues to evolve. While the new uses of transanal platforms in TME for more advanced rectal malignancy are exciting, it is important to remain cognizant and not sacrifice long term survival for short term decrease in morbidity and improved cosmesis.

Treatment of rectal cancer by transanal endoscopic microsurgery: Experience with 425 patients

AIM: To describe our experience in treating rectal cancer by transanal endoscopic microsurgery (TEM), report morbidity and mortality and oncological outcome.

内镜切割吻合器在经肛门局部切除中低位直肠肿瘤中的应用

目的:回顾性分析中低位直肠肿瘤经肛门局部切除治疗中采用内镜切割吻合器的应用价值。方法:纳入我院经检查诊断的24例中低位直肠肿瘤患者,使用内镜切割吻合器对直肠肿瘤进行经肛门局部切除,总结分析患者临床病理资料特征及影像学诊断特点,评价该手术方式的安全性及可行性。结果:24例患者便潜血阳性者14例,症状以便血为主,肿瘤位置以前壁为主。随着肿瘤直径的增大,增强CT、MRI、EUS诊断的准确率升高,准确率方面EUS>MRI>增强CT,三者联合评估准确率提高。术后病理结果显示4例为上皮下来源肿瘤(SM层3例,MP层1例)。20例为上皮来源肿瘤,其中上皮来源良性肿瘤9例,为低级别管状腺瘤或低级混合状腺瘤;高级别上皮内瘤变2例;直肠癌9例,其中M层1例,SM层3例,MP层4例,S层1例。24例患者病灶完全切除率为100%,手术完成率为100%,无中转腹腔镜或开腹手术,手术平均时间、手术平均出血量、术后首次排气平均时间、术后住院平均天数分别为(29.25±6.42)min、(15.04±4.12)mL、(35.38±5.94)h、(3.17±0.92)d;术后7例患者出现WBC反应性升高,术后2~4天后均恢复正常,所有患者RBC及HGB计数较术前均降低,但均处于正常值范围,所有患者均无术后并发症。结论:内镜切割吻合器经肛门切除中低位直肠肿瘤具有操作时间短、副损伤小、术后应激反应低、恢复快的优势,该手术方式具有广泛的临床应用前景。

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0-1 rectal cancer treated with preoperative chemoradiotherapy

BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial.AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection.METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014.Patients with ypT0–1 disease and those who received ACTx were included.The 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the ACTx.RESULTS Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the groups.cT stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection group.CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of resection.Further trials are needed to evaluate the efficacy of ACTx in these group of patients.

低位直肠癌病人肛全直肠系膜切除术后中期排便功能障碍发生风险Nomogram模型构建

目的:分析影响低位直肠癌病人行肛全直肠系膜切除术(transanal total mesorectal excision,TaTME)后中期排便功能障碍发生的危险因素,并建立Nomogram模型。方法:选择2016年1月至2020年1月172例低位直肠癌并接受腹腔镜辅助TaTME手术病人作为建模组,选择2020年2月至2021年2月间接受相同手术病人32例作为验证组;建模组病人根据术后6个月随访时是否发生低位前切除综合征(low anterior resection syndrome,LARS)分为LARS组和非LARS组,比较2组病人病历资料,采用单因素和多因素logistic回归模型对影响LARS发生的独立危险因素进行分析,并采用R软件建立预测低位直肠癌病人TaTME术后LARS发生的列线图模型,并进行验证。结果:病人的LARS评分为(14.78±4.54)分,其中LARS病人84例(48.84%),非LARS病人LARS 88例(51.16%)。单因素、多因素logistic回归分析显示术前放疗、肛门括约肌损伤、吻合口距离肛缘距离、肿瘤直径、坐骨棘间径长度均是影响LARS的独立危险因素(P<0.05~P<0.01)。列线图模型预测建模组、验证组的C-index分别为0.836和0.827。ROC曲线显示,列线图模型预测建模组、验证组发生LARS的AUC分别为0.829、0.808。结论:术前放疗、肛门括约肌损伤、吻合口距离肛缘距离、肿瘤直径、坐骨棘间径长度是影响是否发生LARS的独立危险因素,以上述指标建立的列线图模型具有良好预测效能。

腔镜直线切割吻合器用于T1期中低位直肠癌经肛门局部切除术的疗效及安全性

目的:探讨应用腔镜直线切割吻合器(endoscopic linear cutters, ENDOPATH)行经肛门局部切除术治疗T_(1)期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T_(1)期中低位直肠癌患者的临床资料。根据手术方式分为经肛门局部切除术组(TAE组)与直肠癌传统根治术组(根治术组)。TAE组使用腔镜直线切割吻合器行经肛门全层局部切除术,共39例;根治术组按全直肠系膜切除原则行传统根治术,共53例(包括16例Miles手术和37例Dixon手术)。对两组患者的一般资料、术中及术后相关指标及预后情况进行比较。结果:TAE组和根治术组患者在性别、年龄、肿瘤病理分型、肿瘤大小、距肛缘距离方面对比分析,无显著性差异(P>0.05),两组资料有可比性。两组患者在手术时间[(TAE组:(37.74±10.66)min,根治术组:(117.66±41.78)min]、术后住院时间[TAE组:(6.85±1.06)天,根治术组:(10.70±1.72)天]、术中出血量[TAE组:(30.21±2.97)mL,根治术组:(78.96±12.65)mL]、术后并发症发生率(TAE组:2.56%,根治术组:43.39%)方面差异均有统计学意义(P<0.01)。两组患者的3年无病生存率均为100.00%,两组患者3年内均无复发,相比较无统计学差异(P> 0.05)。两组患者的生存质量评分[TAE组:(90.31±3.82)分,根治术组:(71.59±6.33)分]差异有统计学意义(P<0.01)。结论:与传统根治术相比,应用腔镜直线切割吻合器对T1期中低位直肠癌行经肛门局部切除术同样安全有效。应用腔镜直线切割吻合器行经肛门局部切除术创伤小、并发症少、恢复快,患者术后生活质量等方面明显优于根治术。应用腔镜直线切割吻合器行经肛门局部切除术可作为早期无淋巴转移的中低位直肠癌患者优先选择的一种术式。

腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌根治术中的临床应用

目的:探讨腹腔镜辅助经肛全直肠系膜切除术在低位直肠癌根治术中的应用价值。方法:回顾分析2016年10月至2017年12月为21例低位直肠癌患者行腹腔镜辅助经肛全直肠系膜切除术的临床资料及治疗效果。结果:21例手术均顺利完成,术中出血量60～120 mL,手术时间110～180 min;切除标本远端切缘≥2 cm,环周切缘阴性;术后发生1例吻合口漏、1例肺部感染。病理类型:低分化腺癌3例,中分化腺癌8例,高分化腺癌10例。TNM分期Ⅰ期4例,Ⅱ期9例,Ⅲ期8例。术后8～12 d出院。结论:腹腔镜辅助经肛全直肠系膜切除术治疗低位直肠癌安全、可行,无腹部辅助切口,具有微创、术后康复快、住院费用低等优势,值得推广应用。

腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床体会

目的:探讨腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌的临床价值。方法:选取2018年5月至2019年3月为5例中低位直肠癌患者行腹腔镜辅助经肛门全直肠系膜切除术的相关临床资料。结果:5例均顺利完成手术,无中转开腹,2例行预防性回肠外置,手术时间平均(302.20±51.72)min,术中出血量(102.35±20.20)mL;术后无死亡、吻合口漏等严重并发症发生,肛门功能正常;术后病理结果均为直肠腺癌。术后随访1年以上,未见肿瘤复发转移。结论:腹腔镜辅助经肛门全直肠系膜切除术治疗中低位直肠癌安全、有效,但需严格把握手术适应证及技术要点。

经肛门内镜微创手术治疗直肠肿瘤120例

的探讨经肛门内镜微创手术（transanal endoscopic microsurgery,TEM）治疗直肠肿瘤的应用效果。方法总结2006年4月至2009年11月在本院接受TEM治疗的120例直肠肿瘤患者的临床资料,分析TEM在直肠肿瘤治疗中的应用效果。120例患者直肠病灶平均直径为（1.8±0.8）cm（0.5-5.5cm）,病灶距肛缘平均距离（7.5±2.6）cm（4.0-20.0cm）。病灶在直肠内的部位：前壁43例,后壁30例,左侧壁26例,右侧壁21例。结果本组120例患者的手术方式包括TEM肠壁全层切除106例,黏膜下及部分肌层切除14例。平均手术时间（73.4±31.0）min（25-180min）,术中平均失血（10.7±7.8）ml（3-60ml）。术后病理学检查：直肠腺瘤43例,直肠腺瘤癌变和直肠癌39例（其中Tis期22例,T1期8例,T2期9例）,直肠类癌15例,直肠间质瘤2例,直肠平滑肌瘤1例,炎性息肉等20例;所有标本切缘均为阴性。术后并发肛门出血2例,肺部和泌尿系感染各1例,并发症发生率为3.3%（4/120）。术后平均住院日（3.4±1.3）d（2-8d）。术后平均随访13.5个月,未发现肿瘤复发转移。结论 TEM治疗直肠肿瘤具有手术损伤小、出血少、疗效好、恢复快等优点,是目前直肠局限性肿瘤局部切除的首选方法。

早期中低位直肠癌经肛门切除的疗效分析

目的:探讨早期中低位直肠癌经肛门局部切除术的临床应用价值。方法:回顾性分析2012年至2015年期间我院收治的112例早期中低位直肠癌患者,分为经肛门局部切除组(n=52)和根治性切除组(n=60)。术后标本行常规免疫组化病理检测,同时对比两组患者的各种临床病理特征。结果 :两组患者肿瘤大小、肿瘤距肛缘距离比较差异无统计学意义(P>0.05);术后住院天数、术中出血量、术后并发症发生率及手术时间比较差异有统计学意义(P<0.05)。结论:早期中低位直肠癌经肛门切除与根治性手术比较治疗效果相当,但操作更简便易行,创伤小,恢复快、并发症少、术后生活质量高,具有一定优势,特别是内镜切割吻合器的联合应用,使得该术式更简便易行,在具有适应征患者中可以推广。

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)

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。

经肛门局部切除术治疗中低位T1期直肠癌的效果及预后

目的观察经肛门局部切除术和经腹根治性切除术治疗中低位T1期直肠癌的效果及预后生存情况。方法选取2009年1月—2012年6月收治的96例中低位T1期直肠癌。按照手术方法分为局部组51例和根治组45例,其中局部组行经肛门局部切除术治疗,根治组行经腹根治性切除术治疗。观察2组术中及术后相关指标、术后并发症发生率以及随访情况。结果局部组术中出血量、手术时间、肿瘤距肛缘距离、胃肠道功能恢复时间、住院时间及首次下床活动时间均明显低于根治组(P<0.01)。根治组肺部感染发生率高于局部组(P<0.05)。局部组肛门失禁与性功能障碍的发生率明显低于根治组(P<0.05)。2组5年总生存率和无瘤生存率比较差异无统计学意义(P>0.05)。结论经肛门局部切除术治疗中低位T1期直肠癌的临床疗效肯定,在降低术中出血量、促进胃肠道功能恢复、保护肛门功能和性功能方面明显优于经腹根治性切除术。

腹腔镜辅助经肛门全直肠系膜切除术在中低位直肠癌患者中的临床应用

目的初步探讨腹腔镜辅助经肛门全直肠系膜切除术在中低位直肠癌临床应用的安全性和近期疗效。方法回顾分析2017年9月1日至2019年12月31日我院收治的21例实施了腹腔镜辅助经肛门全直肠系膜切除术的中低位直肠癌患者的临床资料。结果全部21例患者均行了腹腔镜辅助经肛门全直肠系膜切除术,其中男16例,女5例,平均(62.81±12.66)岁,平均BMI (23.89±2.70) kg/m2,行了术前新辅助治疗9例。手术时间平均(178.62±63.75) min,术中出血量平均(50.48±18.57) ml,11例(52. 4%)患者行了末端回肠预防性造口。切除标本肿瘤下缘距切缘(2.16±0.51) cm,术后病理下切缘和环周切缘均为阴性,平均淋巴结检测数目为(15.95±4.46)枚。术后1例患者出现轻症吻合口漏,保守治疗好转;术后住院天数平均为(10.62±5.60)d,所有患者均顺利出院。术后随访3个月-2年,除1例因发生多发肝转移于术后12个月死亡,其余均无复发转移。结论腹腔镜辅助经肛门全直肠系膜切除术能达到直肠癌根治效果,且具有创伤小、术后恢复快的优点,是中低位直肠癌手术患者安全、可靠的选择。

经肛门内镜微创手术治疗直肠肿瘤76例

目的探讨经肛门内镜微创手术(TEM)治疗直肠肿瘤临床应用的疗效。方法选择76例接受TEM临床治疗的的患者资料,分析TEM在直肠肿瘤治疗中应用效果。直肠病灶平均直径为(2.3±0.5)cm(0.7～5.2cm),距齿线平均距离(4.8±2.1)cm(1.5～15.5cm),病灶在直肠内的部位:前壁23例,后壁16例,左侧壁15例,右侧壁22例。结果 76例患者手术方式包括TEM肠壁全层切除63例,黏膜下及部分肌层切除13例。平均手术时间(65.0±35)min(25～180min),平均失血(15.6±8.5)mL(10～80mL)。术后病理学检查:直肠腺瘤22例,直肠腺瘤癌变和直肠癌20例(其中Tis期12例,T1期7例,T2期5例),直肠类癌12例,直肠间质肿瘤7例,直肠平滑肌瘤2例,炎性息肉13例,标本切缘皆为阴性。术后并发肛门出血2例,泌尿系感染1例,并发症发生率3.9%,术后平均住院日(3.4±1.4)d(2～8d)。平均术后随访14.6个月,未发现肿瘤复发转移。结论 TEM治疗直肠肿瘤具有手术损伤小、疗效好、恢复快、切除精确等优点。对于术前诊断肿瘤性质明确及术后明确为T1期癌变者,TEM是一种治愈性的、安全有效的微创手术方法。

经肛门内镜微创手术与标准经肛门局切术对直肠肿瘤疗效及安全性比较的系统评价

目的：比较肛门内镜微创手术和标准经肛门局切术治疗直肠肿瘤的疗效及安全性。方法：检索Pubmed、Embase、The Cochrane Library和中国期刊全文数据库及万方数据库中1990至2015年比较肛门内镜微创手术和标准经肛门局切术治疗直肠肿瘤的随机对照试验或对照试验。使用Rev Man 5.3软件对术后并发症发生率、切缘阴性率、样本破碎率及复发率进行meta分析。结果：共6篇文献927例患者入选研究,其中肛门内镜微创手术组492例,标准经肛门局切术组435例。分析显示肛门内镜微创手术组与标准经肛门局切术组术后并发症发生率（RR=0.92,95%CI=0.65-1.31,P=0.660）的差异无统计学意义。肛门内镜微创手术组切缘阴性率高于标准经肛门局切术组（RR=1.30,95%CI=1.06-1.58,P=0.010）。肛门内镜微创手术组样本破碎率（RR=0.16,95%CI=0.08-0.29,P=0.000）及复发率（RR=0.32,95%CI=0.22-0.46,P=0.000）低于标准经肛门局切术组。结论：肛门内镜微创手术作为一项安全、有效的手术方式,在提高切缘阴性率、降低样本破碎率及复发率方面优于标准经肛门局切术。

早期直肠癌的外科治疗

目的 探讨早期直肠癌手术方式的选择。方法 回顾性分析我院行手术治疗的早期直肠癌 (Ι期 ) 182例患者资料 ,其中行根治术 13 5例 ,行局部切除术 47例。结果 182例患者随访时间为 5～ 2 76个月 ,中位随访时间为 76个月。行直肠癌根治术者 5年生存率为 93 .1% ,局部切除术者为 91.7% (P >0 .0 5 )。T1期直肠癌行根治术者和局部切除者 5年生存率分别为 10 0 %和 94.4% (P >0 .0 5 ) ,T2 期患者分别为 92 .5 %和 83 .3 % (P >0 .0 5 )。T2 期直肠癌局部切除术者 5年局部复发率高于根治术 ,分别为 2 7.3 %和11.1% (P <0 .0 5 )。结论 早期直肠癌行局部切除治疗是一种安全、有效的手术方式 ,对于身体条件差、具有严重合并症的患者 ,可以作为首选的手术方式。

腹腔镜辅助经肛全直肠系膜切除术的疗效分析

目的:比较腹腔镜辅助经肛全直肠系膜切除术(taTME)与传统腹腔镜全直肠系膜切除术(LaTME)治疗低位直肠癌的短期预后。方法:回顾分析2017年1月至2019年12月施行的70例taTME患者的临床资料,根据性别、年龄、体重指数、肿瘤位置、病理分期,匹配同一时期施行的70例LaTME手术,对比两组术中、术后指标。结果:taTME组手术时间、手术标本远切缘距离大于LaTME组(P<0.05),手工吻合比例、术中行保护性造口率高于LaTME组(P<0.05),术后排气时间短于LaTME组(P<0.05),住院费用及术后肠梗阻、尿潴留发生率低于LaTME组(P<0.05)。两组术中出血量、中转开腹率、术后住院时间、手术标本质量、淋巴结检出率、淋巴结阳性率、环周切缘阳性率、肿瘤病理TNM分期、组织学分型及直肠穿孔、前列腺出血、神经血管束出血、CO2栓塞、吻合口漏、吻合口出血、造口出口梗阻等并发症发生率差异均无统计学意义(P>0.05)。结论:taTME治疗低位直肠癌在手术相关指标、标本质量、围手术期并发症发生率、术后恢复速度等短期疗效方面与传统腹腔镜手术相当,且在手术标本远切缘、术后排气时间、住院费用及术后肠梗阻及尿潴留发生率等方面具有优势,值得进一步研究与推广。

经肛门微创系统治疗45例直肠肿瘤的临床分析以及经肛门内镜微创手术的进展

目的探讨经肛门内镜微创手术(TEM)治疗直肠肿瘤的安全性、疗效及预后,评价其临床应用价值及文献复习。方法回顾性分析2014年8月至2017年2月期间于佛山市第一人民医院行TEM治疗的45例直肠肿瘤患者的临床资料,总结其临床效果。结果所有患者的肿瘤病灶均完整切除,肿物直径为1.8±0.8 cm(1.0~4.0 cm),肿瘤距离肛缘为7.6±2.8 cm(6~17 cm);切缘行病理学检查均为阴性,其中全层切除18例,粘膜下及肌层部分切除27例;手术时间为72.7±18.1 min(40~120min),术中失血量的中位数为16.6 m L(5~200 m L);术后住院时间为4.9±1.7 d(4~7 d)。术后病理学检查示单纯直肠腺瘤13例,绒毛管状腺瘤13例,腺瘤伴低级别上皮内瘤变5例,腺瘤伴高级别上皮内瘤变7例,腺瘤癌变5例,均为Tis^T1期;另直肠类癌2例。术后发生创面大出血3例,均经保守治疗治愈;5例肛管及内痔损伤出血术中需加缝肛管创面;无大便失禁及肠穿孔情况。39例患者包括5例癌变患者术后常规随访,随访时间的中位数为15个月(2~30个月),随访期间均未出现肿瘤局部复发,未发生大便失禁和排便功能障碍。结论我们的结果与文献报道结果相近。TEM具有直视下操作、术野暴露清晰、切除范围准确、手术创伤小、复发率低等优点,是一种可用于治疗直肠肿瘤有效的、安全的微创手术方法,应在有条件的医院开展。