早期下消化道癌的微创手术

Minimally invasive surgery for early lower GI cancer.

作者信息

Bemelman W A

机构信息

Consultant Department of Surgery, Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.

出版信息

Best Pract Res Clin Gastroenterol. 2005 Dec;19(6):993-1005. doi: 10.1016/j.bpg.2005.03.003.

DOI:10.1016/j.bpg.2005.03.003

PMID:16338654

Abstract

Two technical developments in colorectal surgery-i.e. transanal endoscopic microsurgery (TEM) and laparoscopic surgery for colorectal disease-are now available for the treatment of early lower GI cancer. Benign lesions and early-stage tumours of the rectosigmoid are amenable for a transanal approach. Transanal endoscopic microsurgery is performed using a rectoscope 4 cm in diameter with a four-port insert. After installation of a pneumorectum, lesions up to 25 cm from the anal verge, including circumferential lesions, can be removed with a recurrence rate of 0-5% for adenomas, 3% for low-risk T1 carcinomas, and 8% for all carcinomas. Laparoscopic-assisted colonoscopic polypectomy, laparoscopic wedge resection or laparoscopic-assisted colostomy have a 67-100% success rate for avoiding a formal bowel resection for benign tumours that cannot be treated by colonoscopy alone. Early colonic cancer requires laparoscopic colectomy guided by preoperative colonoscopy or preoperative endoscopic tattooing for localisation of the affected segment.

摘要

结直肠手术中的两项技术进展，即经肛门内镜显微手术（TEM）和用于结直肠疾病的腹腔镜手术，现已可用于治疗早期下消化道癌。直肠乙状结肠的良性病变和早期肿瘤适合采用经肛门入路。经肛门内镜显微手术使用直径4厘米的直肠镜及四通道插入装置进行。建立直肠充气后，距肛缘25厘米以内的病变，包括环形病变，均可切除，腺瘤的复发率为0 - 5%，低风险T1期癌为3%，所有癌为8%。对于无法单独通过结肠镜治疗的良性肿瘤，腹腔镜辅助结肠镜息肉切除术、腹腔镜楔形切除术或腹腔镜辅助结肠造口术避免进行正规肠切除的成功率为67 - 100%。早期结肠癌需要在术前结肠镜检查或术前内镜纹身引导下进行腹腔镜结肠切除术，以定位受累节段。