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）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 张立泽 , 乔翠霞 , 刘鹏林 ,  赵刚

青岛大学附属医院肛肠科（山东青岛 266003）;

Corresponding author：

赵刚, Email: zhaogang7938@sina.com

Keywords：

直肠肿瘤; 经肛门内镜微创手术; 局部切除; 疗效

DOI：

10.7507/1007-9424.20160289

Video：

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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。

Citation： 张立泽, 乔翠霞, 刘鹏林, 赵刚. 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）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1129-1131. doi: 10.7507/1007-9424.20160289 Copy

1.	詹天成, 李明, 顾晋.解读美国结直肠外科医师协会2013直肠癌治疗指南.中华胃肠外科杂志, 2013, 16(8):701-709.
2.	Kanemitsu T, Kojima T, Yamamoto S, et al. The trans-sphincteric and trans-sacral approaches for the surgical excision of rectal and presacral lesions. Surg Today, 1993, 23(10):860-866.
3.	de Graaf EJ, Doomebosch PG, Stassen LP, et al. Transanal endoscopic microsurgery for rectal cancer. Eur J Cancer, 2002, 38(7):904-910.
4.	Buess G, Theiss R, Günther M, et al. Endoscopic surgery in the rectum. Endoscopy, 1985, 17(1):31-35.
5.	夏立建, 李兆亭.直肠肿瘤局部切除治疗进展.中国肿瘤临床, 2006, 33(22):1312-1315.
6.	林国乐, 邱辉忠, 蒙家兴, 等.经肛门内镜显微手术在直肠肿瘤局部切除术中的应用.中国现代手术学杂志, 2006, 10(5):334-337.
7.	尹路, 陈春球, 赵任, 等.经肛门局部切除低位直肠肿瘤86例临床分析.中国实用外科杂志, 2007, 27(6):462-464.
8.	Allaix ME, Arezzo A, Caldart M, et al. Transanal endoscopic microsurgery for rectal neoplasms:experience of 300 consecutive cases. Dis Colon Rectum, 2009, 52(11):1831-1836.
9.	Tsai BM, Finne CO, Nordenstam JF, et al. Transanal endoscopic microsurgery resection of rectal tumors:outcomes and recommendations. Dis Colon Rectum, 2010, 53(1):16-23.
10.	de Graaf EJ, Burger JW, van Ijsseldijk AL, et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis, 2011, 13(7):762-767.
11.	邱辉忠.经肛门内镜显微手术在直肠肿瘤切除术中的应用.临床外科杂志, 2008, 16(10):656-658.
12.	Christoforidis D, Cho HM, Dixon MR, et al. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg, 2009, 249(5):776-782.
13.	Ramirez JM, Aguilella V, Valencia J, et al. Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results. Int J Colorectal Dis, 2011, 26(4):437-443.
14.	邢飞, 王义秋, 王庄梅.内镜金属夹联合电凝切除老年人结肠巨大息肉62例疗效分析.胃肠病学和肝病学杂志, 2009, 18(12):1086-1087.
15.	Saclarides TJ. Transanal endoscopic microsurgery:a single surgeon's experience. Arch Surg, 1998, 133(6):595-599.
16.	Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer. Dig Dis, 2007, 25(1):20-32.
17.	Perez RO, Habr-Gama A, Sao Juliao GP, et al. Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum, 2011, 54(5):545-551.

1. 詹天成, 李明, 顾晋.解读美国结直肠外科医师协会2013直肠癌治疗指南.中华胃肠外科杂志, 2013, 16(8):701-709.
2. Kanemitsu T, Kojima T, Yamamoto S, et al. The trans-sphincteric and trans-sacral approaches for the surgical excision of rectal and presacral lesions. Surg Today, 1993, 23(10):860-866.
3. de Graaf EJ, Doomebosch PG, Stassen LP, et al. Transanal endoscopic microsurgery for rectal cancer. Eur J Cancer, 2002, 38(7):904-910.
4. Buess G, Theiss R, Günther M, et al. Endoscopic surgery in the rectum. Endoscopy, 1985, 17(1):31-35.
5. 夏立建, 李兆亭.直肠肿瘤局部切除治疗进展.中国肿瘤临床, 2006, 33(22):1312-1315.
6. 林国乐, 邱辉忠, 蒙家兴, 等.经肛门内镜显微手术在直肠肿瘤局部切除术中的应用.中国现代手术学杂志, 2006, 10(5):334-337.
7. 尹路, 陈春球, 赵任, 等.经肛门局部切除低位直肠肿瘤86例临床分析.中国实用外科杂志, 2007, 27(6):462-464.
8. Allaix ME, Arezzo A, Caldart M, et al. Transanal endoscopic microsurgery for rectal neoplasms:experience of 300 consecutive cases. Dis Colon Rectum, 2009, 52(11):1831-1836.
9. Tsai BM, Finne CO, Nordenstam JF, et al. Transanal endoscopic microsurgery resection of rectal tumors:outcomes and recommendations. Dis Colon Rectum, 2010, 53(1):16-23.
10. de Graaf EJ, Burger JW, van Ijsseldijk AL, et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis, 2011, 13(7):762-767.
11. 邱辉忠.经肛门内镜显微手术在直肠肿瘤切除术中的应用.临床外科杂志, 2008, 16(10):656-658.
12. Christoforidis D, Cho HM, Dixon MR, et al. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg, 2009, 249(5):776-782.
13. Ramirez JM, Aguilella V, Valencia J, et al. Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results. Int J Colorectal Dis, 2011, 26(4):437-443.
14. 邢飞, 王义秋, 王庄梅.内镜金属夹联合电凝切除老年人结肠巨大息肉62例疗效分析.胃肠病学和肝病学杂志, 2009, 18(12):1086-1087.
15. Saclarides TJ. Transanal endoscopic microsurgery:a single surgeon's experience. Arch Surg, 1998, 133(6):595-599.
16. Karantanas AH, Yarmenitis S, Papanikolaou N, et al. Preoperative imaging staging of rectal cancer. Dig Dis, 2007, 25(1):20-32.
17. Perez RO, Habr-Gama A, Sao Juliao GP, et al. Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum, 2011, 54(5):545-551.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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）

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