McCloud J M, Waymont N, Pahwa N, Varghese P, Richards C, Jameson J S, Scott A N D
Department of General Surgery, Glenfield Hospital, Leicester, UK.
Colorectal Dis. 2006 Sep;8(7):581-5. doi: 10.1111/j.1463-1318.2006.01016.x.
Transanal endoscopic microsurgery (TEM) is an accepted way of excising rectal adenomas with low morbidity and mortality, avoiding major resectional surgery. However, there are no agreed criteria for surveillance following TEM. The purpose of this study was to identify criteria to guide surveillance programmes, thus reducing the surveillance burden for those patients at low risk of recurrence.
Patients who had undergone TEM for rectal adenomas were identified, and a retrospective review of patient, pathological and histological parameters was performed.
Seventy-five (40 male) patients were identified; median age 70 years (39-85). There were seven tubular, 33 tubulo-villous and 35 villous adenomas. All were considered completely excised by the operating surgeon. Forty-seven (62.7%) were reported as being completely excised histologically. There was no significant association between recurrence at 6 months and sex, age, type or position of adenoma, height above the anal verge, or degree of dysplasia. Recurrence rates at six months were 0% for the completely excised adenomas and 21.4% for the incompletely excised ones; this was statistically significant (Pearson chi(2), P < 0.001). In all there were 12 recurrences, 10 in the incompletely excised group at a median follow up of 31 (6-80) months (P < 0.001). In addition, a significant association for large adenomas to recur was noted at median follow up (Armitage Trend test, P = 0.019).
Histological assessment of completeness of excision of rectal adenoma and size of adenoma are important predictors of early recurrence and have potential to guide follow-up strategies after TEM.
经肛门内镜显微手术（TEM）是一种公认的切除直肠腺瘤的方法，其发病率和死亡率较低，可避免进行大型切除手术。然而，TEM术后的监测尚无统一标准。本研究的目的是确定指导监测方案的标准，从而减轻那些复发风险较低患者的监测负担。
确定接受过直肠腺瘤TEM手术的患者，并对患者、病理和组织学参数进行回顾性分析。
共确定了75例患者（40例男性）；中位年龄70岁（39 - 85岁）。其中有7例管状腺瘤、33例管状绒毛状腺瘤和35例绒毛状腺瘤。所有腺瘤均被手术医生认为已完全切除。47例（62.7%）在组织学上报告为完全切除。6个月时的复发与性别、年龄、腺瘤类型或位置、齿状线以上高度或发育异常程度之间无显著关联。完全切除的腺瘤6个月复发率为0%，未完全切除的为21.4%；差异具有统计学意义（Pearson卡方检验，P < 0.001）。总共出现12例复发，10例在未完全切除组，中位随访时间为31个月（6 - 80个月）（P < 0.001）。此外，在中位随访时发现大腺瘤复发存在显著关联（Armitage趋势检验，P = 0.019）。
直肠腺瘤切除完整性的组织学评估和腺瘤大小是早期复发的重要预测因素，有可能指导TEM术后的随访策略。
