Hong Kwang Dae, Kang Sanghee, Urn Jun Won, Lee Sun Il
Hepatogastroenterology. 2015 Jun;62(140):863-7.
BACKGROUND/AIMS: Transanal minimally invasive surgery (TAMIS) has received attention as an alternative to transanal endoscopic microsurgery for rectal lesions. We review the effectiveness and safety of TAMIS for the treatment of rectal lesions.
The MEDLINE, Web of Science, and Cochrane Library databases were searched using predefined inclusion criteria. The primary outcomes were positive margin rate, recurrence rate, conversion rate, range of applications, and complication rates. To derive pooled estimates of proportions with 95% Confidence Interval (CI) for the outcomes, a random effect model was used.
Twelve studies including 155 patients were identified. The weighted mean size of rectal lesions was 3.3 cm (range 0.2-10 cm) and the weighted mean distance from the anal verge was 7.4 cm (range 0-20 cm). Six studies enrolled only the patients with low and mid rectal lesions mainly to avoid peritoneal entrance during excision.
Based on the evidence from this limited number of studies, TAMIS appears to be an effective and safe treatment for rec tal lesions. However, the clinical outcome of TAMIS according to the location of the rectal lesions needs to be clarified. Comparison with other established surgical treatments are also mandatory.
背景/目的：经肛门微创手术（TAMIS）作为直肠病变经肛门内镜显微手术的替代方法已受到关注。我们回顾了TAMIS治疗直肠病变的有效性和安全性。
使用预定义的纳入标准检索MEDLINE、科学网和考克兰图书馆数据库。主要结局指标为切缘阳性率、复发率、中转率、应用范围和并发症发生率。为得出结局指标的95%置信区间（CI）的合并比例估计值，采用随机效应模型。
共纳入12项研究，涉及155例患者。直肠病变的加权平均大小为3.3 cm（范围0.2 - 10 cm），距肛缘的加权平均距离为7.4 cm（范围0 - 20 cm）。6项研究仅纳入了直肠中低位病变患者，主要是为了避免切除过程中进入腹腔。
基于这有限数量研究的证据，TAMIS似乎是治疗直肠病变的一种有效且安全的方法。然而，TAMIS根据直肠病变位置的临床结局仍需阐明。与其他既定手术治疗方法的比较也必不可少。
