摘要
目的探讨经肛门内镜显微手术（transanal endoscopicmic rosurgery，TEM）治疗直肠绒毛状腺瘤和早期直肠癌的疗效。方法1995年11月～2003年12月，我院行TEM治疗直肠肿瘤31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下，采用针形电刀或5mm超声刀将直肠肿瘤完整切除（黏膜下或全层切除），手术创口在腔内连续缝合。结果31例直肠肿瘤均获完整切除，切缘均阴性。手术时间45～220min，平均95min；术中出血量0～180ml，平均40ml。手术并发症：暂时性排气失控2例，急性尿潴留1例，慢性阻塞性气道疾病急性发作1例，因服用阿斯匹林而出现继发性出血1例。术后病理分期：pT0期16例，pTis期2例，pT1期7例，pT2和pT3期各3例。31例随访2～92个月，平均23个月，肿瘤无原位复发。结论TEM是治疗直肠绒毛状腺瘤和早期直肠癌的一种安全、有效的微创手术方法。
Objective To investigate outcomes of transanal endoscopic microsurgery （TEM） for the treatment of rectal villous adenoma and early - stage rectal carcinoma. Methods A series of 31 patients with rectal tumors underwent TEM from November 1995 to December 2003. 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 CO2 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 31 patients. The operating time was 45 -220 min （mean, 95 min） and the intraoperative blood loss was 0 - 180 ml （mean, 40 ml）. Complications included temporary flatus incontinence in 2 patients, acute retention of urine in 1 patient, exacerbation of chronic obstructive airway disease in 1, and secondary hemorrhage following Aspirin taking in 1. The postoperative pathological stages were pT0 in 16 patients, pTi, in 2 patients, pT1 in 7, pT2 in 3, and pT3 in 3. Follow - up checkups in the 31 patients for 2 - 92 months （mean, 23 months） revealed no local recurrence. Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal villous adenoma and early rectal carcinoma.
出处
《中国微创外科杂志》
CSCD
2006年第1期15-18,共4页
Chinese Journal of Minimally Invasive Surgery
