He Yong-gang, Han Yi, Hua Zhi-li, Lin Mou-bin, Zhang Hao-bo, Lv Ke-zhi, Yin Lu
Department of Surgery, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Dec;13(12):910-2.
To evaluate the safety and outcomes after transanal endoscopic microsurgery (TEM)for rectal adenoma.
Data of 32 patients undergoing TEM for rectal adenoma between September 2006 and February 2010 in the Ruijin Hospital were reviewed.
The adenoma diameter ranged from 0.6 to 10.0(2.3±1.2) cm. The mean operative time was 70(range,20-180) min. The estimated blood loss was less than 10 ml. There were no conversions to transabdominal procedure. Twenty-two(68.8%) patients underwent suturing of the wound, of whom 14 had full-thickness resection. Two patients had perforation into peritoneal cavity during full-thickness resection, which were repaired by continuous suturing and no postoperative leak occurred. R0 resection was achieved in 31(96.9%) patients. Postoperative pathology showed 12 simple adenomas, 10 adenomas with low grade intraepithelial neoplasia, 5 adenomas with high grade intraepithelial neoplasia, and 5 T1 focal carcinomas. Complications included rectal bleeding in 1 patient, acute urinary retention in 1 patient, and pulmonary infection in 1 patient. The postoperative stay was 4.5(3-8) days. The patients were followed-up for a period of 23 months(range, 2-43 months). There were 2 tumors recurred.
TEM is a safe and effective minimally invasive surgical technique for large rectal adenomas.
评估经肛门内镜显微手术（TEM）治疗直肠腺瘤的安全性及手术效果。
回顾性分析2006年9月至2010年2月在瑞金医院接受TEM治疗直肠腺瘤的32例患者的资料。
腺瘤直径为0.6至10.0（2.3±1.2）cm。平均手术时间为70（范围20 - 180）分钟。估计失血量少于10ml。无一例中转开腹手术。22例（68.8%）患者行伤口缝合，其中14例行全层切除。2例患者在全层切除时发生腹腔穿孔，经连续缝合修补，术后无渗漏发生。31例（96.9%）患者实现R0切除。术后病理显示12例单纯腺瘤，10例腺瘤伴低级别上皮内瘤变，5例腺瘤伴高级别上皮内瘤变，5例T1期局灶性癌。并发症包括1例直肠出血、1例急性尿潴留和1例肺部感染。术后住院时间为4.5（3 - 8）天。患者随访23个月（范围2 - 43个月）。有2例肿瘤复发。
TEM是一种治疗大型直肠腺瘤安全有效的微创手术技术。
