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经肛门内镜微创手术(TEM)在直肠癌患者中的适应证。

Indications for performing transanal endoscopic microsurgery (TEM) in rectal cancer patients.

机构信息

Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan, Department of Surgery, Iizuka Hospital, Fukuoka, Japan, Department of Surgery, Medical Institute of Bioregulation, Kyushu University, Beppu, Fukuoka, Japan, Department of Gastroenterology, Iizuka Hospital, Fukuoka, Japan.

出版信息

Colorectal Dis. 2000 Jan;2(1):13-7. doi: 10.1046/j.1463-1318.2000.00131.x.

Abstract

OBJECTIVE

The aim of this study was to clarify the application of a local excision using TEM for rectal cancer.

PATIENTS AND METHODS

Fifteen patients were preoperatively diagnosed to have cancer invasion in the submucosa (T1) and thus were treated by TEM, while 13 others were preoperatively diagnosed to have cancer invasion reaching the muscularis propria (T2) and thus were treated by a radical operation. Surgical specimens from all 28 patients were pathologically examined and compared with the preoperative evaluation.

RESULTS

The mean operating time for TEM was 53 min. The accuracy of the preoperative evaluation for the depth of cancer invasion was 68% (19/28). In the 15 patients with preoperative evaluation of T1 cancer, two pathologically showed cancer invasion into muscularis propria. In the 13 patients with a preoperative evaluation of T2 cancer, three pathologically showed cancer invasion within the submucosa.

CONCLUSION

Since some patients with a preoperative evaluation of T2 rectal cancer showed the possibility of a complete cure with a local excision, preoperative T2 stage rectal cancer is considered to be a good candidate for a local excision using TEM.

摘要

目的

本研究旨在阐明经肛门内镜微创手术(TEM)用于治疗直肠癌的应用。

患者与方法

术前诊断为黏膜下层浸润(T1)的 15 例患者接受 TEM 治疗,术前诊断为固有肌层浸润(T2)的 13 例患者接受根治性手术治疗。对所有 28 例患者的手术标本进行病理检查,并与术前评估进行比较。

结果

TEM 的平均手术时间为 53 分钟。术前评估癌症浸润深度的准确性为 68%(28/28)。术前评估为 T1 期癌症的 15 例患者中,有 2 例病理检查显示癌症侵犯固有肌层。术前评估为 T2 期癌症的 13 例患者中,有 3 例病理检查显示癌症侵犯黏膜下层。

结论

由于术前评估为 T2 期的部分直肠癌患者通过局部切除可能获得完全治愈,因此术前评估为 T2 期的直肠癌患者是 TEM 局部切除的良好候选者。

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