【摘要】 目的探讨经肛门内镜下手术治疗直肠腺瘤和早期直肠癌的疗效。方法 2011年6月至2012年6月,在吉林大学第二医院行TEM治疗的直肠肿瘤患者21例。全麻下根据肿瘤位置选择合适的体位,经肛门插入特殊的手术直肠镜,保持CO2充气状态,在立体视镜和腔镜系统辅助下,采用针形电刀或5 mm超声刀将直肠肿瘤完整切除(黏膜下或全层切除),在腔内连续缝合手术创口。结果 21例直肠肿瘤患者均获完整切除,术中快速病理确定切缘均阴性。手术时间45~160 min,平均90 min;术中出血量0~60 ml,平均15 ml。手术并发症:发热5例,急性尿潴留1例,因长期服用阿司匹林出血2例。术后病理分期:T0期11例,Tis期5例,T1期3例,T2期2例。21例均随访12个月,肿瘤无原位复发及远处转移。结论 TEM是治疗直肠腺瘤和早期直肠癌的一种安全、有效的微创手术方法。更多还原

【Abstract】 Objective To investigate outcomes of transanal endoscopic microsurgery( TEM) for the treatment of rectal adenoma and early-stage rectal carcinoma. Methods Twenty-one patients with rectal tumors underwent TEM from June 2011 to June 2012. The operation was performed under general anesthesia. The patients were placed in a dependent position dictated by the location of the tumor. A special rectoscope was inserted into the anus with CO 2 insufflation to keep the rectum open. Under the stereoscope and laparoscopic-type instruments,the tumor was completely resected( submucosal or full-thickness excision) using a needle diathermy or a 5-mm ultrasonic dissector. The operative wound was closed with intra-lumen continuous sutures. Results The rectal tumor was completely removed with negative resection margins in all the 21 patients. The operating time was 45 ~ 160 min( mean,90 min) and the intraoperative blood loss was 0 ~ 60 ml( mean,15 ml). Complications included fever in 5 patients,acute retention of urine in 1 patient,and secondary hemorrhage following Aspirin taking in 2 patients. The postoperative pathological stages were T 0 in 11 patients,Tis in 5 patients,T 1 in 3,and T 2 in 2. Follow-up checkups in the 21 patients until now revealed no local recurrence and distant metastasis. Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal adenoma and early rectal carcinoma.更多还原