Bloomfield Ian, Van Dalen Roelof, Lolohea Simione, Wu Linus
Department of Colorectal Surgery, Waikato Hospital, Hamilton, New Zealand.
ANZ J Surg. 2018 Jun;88(6):592-596. doi: 10.1111/ans.14142. Epub 2017 Dec 3.
Transanal endoscopic microsurgery (TEMS) is a proven alternative therapy to either radical surgery or endoscopic mucosal resection for rectal neoplasms. It has proven benefits with lower morbidity and mortality compared with total mesorectal excision, and a lower local recurrence rate when compared to endoscopic mucosal techniques.
A retrospective data collection of TEMS procedures performed through Waikato District Health Board, New Zealand, from 2010 to 2015 was conducted. Supportive follow-up data were sourced from patient records and from local centres around New Zealand.
A total of 137 procedures were performed over the study period, with five being repeat procedures. Procedures were mostly performed for benign lesions (66.4%) with an overall complication rate of 15.3%, only five of which were Clavien-Dindo grade III (3.6%). Our local recurrence rate after resection of benign lesions was 5.1%.
Our data set demonstrates the TEMS procedure to be safe compared to radical resection (total mesorectal excision) for sessile rectal lesions. Close endoscopic follow-up is recommended, especially for close or incomplete margins. Good therapeutic results can be obtained for appropriately selected early malignant lesions. TEMS provides better oncological results than endoscopic mucosal resection or transanal excision.
经肛门内镜显微手术（TEMS）是一种已被证实的直肠肿瘤治疗方法，可替代根治性手术或内镜黏膜切除术。与全直肠系膜切除术相比，它具有较低的发病率和死亡率，与内镜黏膜技术相比，局部复发率更低。
对2010年至2015年在新西兰怀卡托地区卫生局进行的TEMS手术进行回顾性数据收集。支持性随访数据来自患者记录和新西兰各地的当地中心。
在研究期间共进行了137例手术，其中5例为重复手术。手术大多针对良性病变（66.4%），总体并发症发生率为15.3%，其中只有5例为Clavien-DindoⅢ级（3.6%）。良性病变切除后的局部复发率为5.1%。
我们的数据集表明，对于无蒂直肠病变，与根治性切除（全直肠系膜切除术）相比，TEMS手术是安全的。建议进行密切的内镜随访，尤其是对于切缘接近或不完全的情况。对于适当选择的早期恶性病变，可获得良好的治疗效果。TEMS比内镜黏膜切除术或经肛门切除术具有更好的肿瘤学效果。
