协和医学杂志

2011, v.2(01) 33-36

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经肛门内镜微创手术治疗直肠肿瘤120例
Application of Transanal Endoscopic Microsurgery in 120 Patients with Rectal Neoplasms

邱辉忠;林国乐;肖毅;吴斌;
QIU Hui-zhong,LIN Guo-le,XIAO Yi,WU Bin Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目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。
Objective To investigate the effectiveness of transanal endoscopic microsurgery(TEM)in treating rectal neoplasms.Methods The clinical data of 120 patients with rectal neoplasms which were treated using TEM between April 2006 and November 2009 were summarized and analyzed retrospectively.The mean diameter of rectal lesions was(1.8±0.8)cm(range:0.5-5.5 cm).The average distance of lesions from the anal verge was(7.5±2.6)cm(range,4-20 cm).The orientations of the lesions at the rectal wall were as follows:43 at the anterior wall,30 at the posterior wall,26 at the left wall,and 21 at the right wall.Results Surgical procedures included the transmural excision(n=106)and the submucosal excision with partial muscular layer excision(n=14).The average operating time was(73.4±31.1)min(range,25-180 min).The mean intra-operative blood loss was(10.7±7.8)ml(range,3-60 ml).The postoperative pathological examination identified 43 retcal adenomas,39 rectal adenocarcinomas or carcinomatous changes of adenomas(22 Tis,8 T1,and 9 T2 cases),15 rectal carcinoids,2 stromal tumor,1 leiomyoma,and 20 inflammatory polyps or others.Surgical margins of all specimens were negative.Postoperative complications included anal hemorrhage(n=2),pulmonary infection(n=1),and urinary infection(n=1),making a postoperative morbidity of 3.3%.The average postoperative hospital stay was(3.4±1.3)d(range,2-8 d).With a mean follow-up of 13.5 months(range,3-4 months),no tumor recurrence or metastasis was observed.Conclusions TEM is a minimally invasive surgery and has advantages of low intra-operative blood loss,better therapeutic effectiveness,and faster recovery.It has became a preferred procedure for local excision of rectal neoplasms.

关键词(KeyWords): 直肠肿瘤;经肛门内镜微创手术;局部切除
rectal neoplasms;transanal endoscopic microsurger;local excision

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作者(Author): 邱辉忠;林国乐;肖毅;吴斌;
QIU Hui-zhong,LIN Guo-le,XIAO Yi,WU Bin Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Science & Peking Union Medical College,Beijing 100730,China

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