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目的评估经肛门内镜显微手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤临床应用的安全性、可行性及疗效,探讨手术中操作难点的处理策略。方法回顾性分析上海交通大学医学院附属瑞金医院外科2006年9月至2010年2月期间53例经肛门内镜显微手术病人的临床资料。结果共53例直肠肿瘤病人接受TEM手术治疗,其中直肠腺瘤28例,直肠类癌7例,直肠癌15例,炎性肿块2例,淋巴瘤1例,96.2%病人切缘阴性。术后并发症:2例肛门出血,1例急性尿潴留,1例肺部感染,1例暂时性排便失禁。术后平均住院天数为4.8(3~9)d。平均随访23(2~43)个月,腺瘤组出现2例复发,腺癌组出现2例复发,类癌组无复发。结论 TEM是一种对直肠中、上段及乙状结肠下段肿瘤安全、有效的微创手术方法。
Objective To evaluate the safety, feasibility and efficacy of transanal endoscopic microsurgery (TEM) in the treatment of rectal tumors and to explore the treatment strategies for the difficult operation in the operation. Methods The clinical data of 53 patients undergoing transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. Results Totally 53 rectal tumors were treated by TEM. Among them, 28 were rectal adenomas, 7 were rectal carcinoids, 15 were rectal cancer, 2 were inflammatory mass, 1 was lymphoma, and 96.2% were negative margins. Postoperative complications: 2 cases of anal bleeding, 1 case of acute urinary retention, 1 case of pulmonary infection, 1 case of temporary bowel movement incontinence. The average postoperative hospital stay was 4.8 (3-9) days. With an average follow-up of 23 months (range 2 ~ 43), two cases of adenoma recurrence, two cases of adenocarcinoma recurrence, and no recurrence of carcinoid tumor. Conclusion TEM is a safe and effective minimally invasive surgery for the middle and upper rectum of the rectum and the lower sigmoid colon.