經肛門內鏡微創手術治療直腸腫瘤療效的臨床分析（附26例報道）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 張立澤 , 喬翠霞 , 劉鵬林 ,  趙剛

青島大學附屬醫院肛腸科（山東青島 266003）;

Corresponding?author：

趙剛, Email: zhaogang7938@sina.com

Keywords：

直腸腫瘤; 經肛門內鏡微創手術; 局部切除; 療效

DOI：

10.7507/1007-9424.20160289

Video：

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目的探討經肛門內鏡微創手術（transanal endoscopic microsurgery，TEM）治療直腸腫瘤的療效及預后，評價其臨床應用價值。方法回顧性分析2012年8月至2014年11月期間于青島大學附屬醫院行TEM治療的26例直腸腫瘤患者的臨床資料，總結其臨床效果。結果所有患者的腫瘤病灶均完整切除，切緣行病理學檢查均為陰性。手術時間為（70.7±22.1）min（40～120 min），術中失血量的中位數為9.8 mL（5～30 mL）；術后住院時間為（5.4±2.2）d（4～9 d）。術后病理學檢查示單純直腸腺瘤12例，腺瘤伴低級別上皮內瘤變8例，腺瘤伴高級別上皮內瘤變2例，腺瘤局灶癌變2例，均為T1期；直腸類癌2例。術后發生大便帶血1例，一過性大便失禁2例。26例患者術后均獲訪，隨訪時間的中位數為9個月（6～18個月）。隨訪期間均未出現腫瘤局部復發，未發生控便和排便功能障礙。結論 TEM的術野暴露良好、切除范圍準確、術后恢復快、復發率低，是一種可用于治療直腸腫瘤，特別是位于直腸中上段的良性腫瘤及早期直腸癌的安全而有效的微創手術方法。

Citation： 張立澤, 喬翠霞, 劉鵬林, 趙剛. 經肛門內鏡微創手術治療直腸腫瘤療效的臨床分析（附26例報道）. 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, 顧晉.解讀美國結直腸外科醫師協會2013直腸癌治療指南.中華胃腸外科雜志, 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.直腸腫瘤局部切除治療進展.中國腫瘤臨床, 2006, 33(22):1312-1315.
6.	林國樂, 邱輝忠, 蒙家興, 等.經肛門內鏡顯微手術在直腸腫瘤局部切除術中的應用.中國現代手術學雜志, 2006, 10(5):334-337.
7.	尹路, 陳春球, 趙任, 等.經肛門局部切除低位直腸腫瘤86例臨床分析.中國實用外科雜志, 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.	邱輝忠.經肛門內鏡顯微手術在直腸腫瘤切除術中的應用.臨床外科雜志, 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.	邢飛, 王義秋, 王莊梅.內鏡金屬夾聯合電凝切除老年人結腸巨大息肉62例療效分析.胃腸病學和肝病學雜志, 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, 顧晉.解讀美國結直腸外科醫師協會2013直腸癌治療指南.中華胃腸外科雜志, 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.直腸腫瘤局部切除治療進展.中國腫瘤臨床, 2006, 33(22):1312-1315.
6. 林國樂, 邱輝忠, 蒙家興, 等.經肛門內鏡顯微手術在直腸腫瘤局部切除術中的應用.中國現代手術學雜志, 2006, 10(5):334-337.
7. 尹路, 陳春球, 趙任, 等.經肛門局部切除低位直腸腫瘤86例臨床分析.中國實用外科雜志, 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. 邱輝忠.經肛門內鏡顯微手術在直腸腫瘤切除術中的應用.臨床外科雜志, 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. 邢飛, 王義秋, 王莊梅.內鏡金屬夾聯合電凝切除老年人結腸巨大息肉62例療效分析.胃腸病學和肝病學雜志, 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

經肛門內鏡微創手術治療直腸腫瘤療效的臨床分析（附26例報道）

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