Gracia Solanas J A, Ramírez Rodríguez J M, Aguilella Diago V, Elía Guedea M, Martínez Díez M
Section of Coloproctology, Department of Surgery 'B'. Hospital Clínico Universitario, Zargoza, Spain.
Rev Esp Enferm Dig. 2006 Apr;98(4):234-40. doi: 10.4321/s1130-01082006000400002.
transanal endoscopic microsurgery (TEM) was developed in 1983 by Büess as a minimally invasive technique to manage rectal villous adenomas and early rectal adenocarcinomas. Many studies have been published worldwide about its excellent results in morbidity and recidive rate, but there are few studies addressing functional results. The objective of this study is to analyze the effect of this technique in the anal anatomy and compare with the manometric results.
we devised a prospective study of 40 patients. 39% female, 61% male. All of them filled an incontinence questionnaire (Pescatori scale) and endoanal ultrasonography and manometry was carried out preoperatively, third month postoperative and at sixth month only if incontinence appeared.
32 patients (80%) had villous adenomas and 8 patients (20%) had adenocarcinomas (uT1). Three patients complained of flatus incontinence at 3rd postoperative month that disappeared with normal continence at 6th month. Anorectal manometric values: mean anal resting pressure (ARP) decreased at 3rd month (from 87.2 mmHg to 70.1 mmHg), as it was for maximal squeeze pressure (MSP) from 152.5 mmHg preoperatively to 142.2 mmHg at 3rd month. Ultrasonography demonstrated internal anal sphincter (IAS) rupture in 3 patients, with a full integrity of the external anal sphincter in all patients.
during TEM, a significant anal dilatation occurs, because of rectoscopy (40 mm wide), what can produce a rupture of IAS, with the consequent decreasing in ARP, and a dilatation without rupture of external sphincter what produces a decreasing of MSP. The fall of anal pressures had minima clinical repercussion when sphincter is intact, but when IAS is broken a temporal incontinence develops.
经肛门内镜显微手术（TEM）由比埃斯于1983年开发，是一种用于治疗直肠绒毛状腺瘤和早期直肠腺癌的微创技术。世界各地已发表了许多关于其在发病率和复发率方面出色结果的研究，但涉及功能结果的研究较少。本研究的目的是分析该技术对肛门解剖结构的影响，并与测压结果进行比较。
我们设计了一项针对40名患者的前瞻性研究。女性占39%，男性占61%。他们都填写了一份失禁问卷（佩斯卡特里量表），并在术前、术后第三个月进行了肛门内超声检查和测压，仅在出现失禁情况时于术后第六个月进行检查。
32例患者（80%）患有绒毛状腺瘤，8例患者（20%）患有腺癌（uT1）。3例患者在术后第三个月出现排气失禁，在第六个月恢复正常控便。肛门直肠测压值：平均肛门静息压（ARP）在第三个月下降（从87.2 mmHg降至70.1 mmHg），最大收缩压（MSP）也从术前的152.5 mmHg降至第三个月的142.2 mmHg。超声检查显示3例患者肛门内括约肌（IAS）破裂，所有患者的肛门外括约肌均完整无损。
在TEM手术过程中，由于直肠镜（40毫米宽）的原因会出现明显的肛门扩张，这可能导致IAS破裂，从而使ARP降低，而外括约肌未破裂的扩张会导致MSP降低。当括约肌完整时，肛门压力下降对临床影响极小，但当IAS破裂时会出现暂时性失禁。
