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Transanal Endoscopic Microsurgery of Rectal Cancer

Treatment of Rectal Tumor by Transanal Endoscopic Microsurgery （Report of 7 Cases）

目的　探讨经肛门内镜显微手术(TEM)治疗直肠肿瘤的疗效。方法　回顾性分析2009年1~12月期间我院行TEM治疗7例直肠腺瘤患者的临床资料。结果　7例直肠肿瘤均获完整切除，切缘均阴性。手术时间55～240 min，平均110 min; 术中出血量5～100 ml,平均45 ml。术后病理诊断: 直肠绒毛状腺瘤4例，绒毛管状腺瘤2例，直肠腺癌1例。手术并发症: 术中直肠穿孔1例，肺部感染1例，尿潴留1例。　7例随访6~13个月,平均8个月，肿瘤无复发。结论　TEM治疗直肠肿瘤安全、有效。

经肛门内镜微创手术治疗直肠肿瘤疗效的临床分析（附26例报道）

目的探讨经肛门内镜微创手术（transanal endoscopic microsurgery，TEM）治疗直肠肿瘤的疗效及预后，评价其临床应用价值。 方法回顾性分析2012年8月至2014年11月期间于青岛大学附属医院行TEM治疗的26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，切缘行病理学检查均为阴性。手术时间为（70.7±22.1）min（40～120 min），术中失血量的中位数为9.8 mL（5～30 mL）；术后住院时间为（5.4±2.2）d（4～9 d）。术后病理学检查示单纯直肠腺瘤12例，腺瘤伴低级别上皮内瘤变8例，腺瘤伴高级别上皮内瘤变2例，腺瘤局灶癌变2例，均为T1期；直肠类癌2例。术后发生大便带血1例，一过性大便失禁2例。26例患者术后均获访，随访时间的中位数为9个月（6～18个月）。随访期间均未出现肿瘤局部复发，未发生控便和排便功能障碍。 结论TEM的术野暴露良好、切除范围准确、术后恢复快、复发率低，是一种可用于治疗直肠肿瘤，特别是位于直肠中上段的良性肿瘤及早期直肠癌的安全而有效的微创手术方法。

Research progress of transanal endoscopic microsurgery for rectal tumors

Objective To summarize the research progress of transanal endoscopic microsurgery in the treatment of rectal tumors. Method The literatures on transanal endoscopic treatment of rectal tumors was collected and reviewed. ResultsTransanal endoscopic microsurgery was one of the local resection methods. It was a minimally invasive surgery combining laparoscopy and endoscopy. Transanal endoscopic microsurgery equipment was mainly composed of special rectal mirror lens and high-pressure pneumoperitoneum machine. After full-thickness resection of the lesion, the defect was sutured under endoscopy, so as to avoid serious postoperative complications caused by radical surgery. Transanal endoscopic microsurgery was suitable for T1 stage rectal cancer with benign lesions such as rectal adenoma and rectal polyps and no lymph node metastasis. There was still some controversy about the treatment of higher-grade rectal cancer. Neoadjuvant radiotherapy and chemotherapy combined with transanal endoscopic microsurgery is being actively carried out in the treatment of rectal cancer. Conclusions Transanal endoscopic microsurgery is a safe and effective method for some rectal tumors. It has the characteristics of low perioperative complication rate, fast postoperative recovery and low recurrence rate.