Wu Xin, Lin Guole, Qiu Huizhong, Zhou Jiaolin
Department of General Surgery, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China .
J Laparoendosc Adv Surg Tech A. 2018 May;28(5):546-552. doi: 10.1089/lap.2017.0606. Epub 2017 Dec 13.
Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. Rare rectal tumors consist of several different types of malignant or benign tumors. Surgical management is considered to be the only curative option. The aim of this study is to investigate the role of TEM in the treatment of rare rectal tumors.
A total of 147 patients with rare rectal tumors underwent TEM in our center from April 2006 to May 2017. Clinical data were collected and a retrospective accurate database was constructed. Demographic characteristics, operative details, tumor details, complications, and follow-up data were analyzed.
Seventy-eight patients were male. Mean tumor diameter was 1.2 ± 0.7 cm and mean distance from the anal verge was 6.6 ± 2.3 cm. Full-thickness and complete resection with negative margins was achieved in all patients. Complications occurred in 3 patients during surgery and in 20 patients after surgery. Histopathologic results were neuroendocrine tumors in 104 patients; gastrointestinal stromal tumors in 35; melanoma, lymphoma, and leiomyoma each in 2; lipoma, and squamous carcinoma each in 1. One hundred thirty-five patients were followed up for 49.3 ± 33.2 months. Two patients died, 1 had local recurrence and 1 had a rectovaginal fistula 1 month after surgery. No local recurrence or metastasis, or fecal incontinence was observed in the remaining patients.
TEM is an optimal treatment option for selected rare rectal tumors. The complication rate is low and the therapeutic effect is satisfactory.
经肛门内镜显微手术（TEM）已在全球范围内被广泛用于治疗局部直肠病变。罕见直肠肿瘤由几种不同类型的恶性或良性肿瘤组成。手术治疗被认为是唯一的治愈选择。本研究旨在探讨TEM在罕见直肠肿瘤治疗中的作用。
2006年4月至2017年5月，共有147例罕见直肠肿瘤患者在本中心接受了TEM手术。收集临床数据并建立回顾性精确数据库。分析人口统计学特征、手术细节、肿瘤细节、并发症及随访数据。
男性患者78例。肿瘤平均直径为1.2±0.7 cm，距肛缘平均距离为6.6±2.3 cm。所有患者均实现了全层完整切除且切缘阴性。3例患者术中出现并发症，20例患者术后出现并发症。组织病理学结果显示，神经内分泌肿瘤104例；胃肠道间质瘤35例；黑色素瘤、淋巴瘤和平滑肌瘤各2例；脂肪瘤和鳞状细胞癌各1例。135例患者接受了49.3±33.2个月的随访。2例患者死亡，1例术后1个月出现局部复发，1例出现直肠阴道瘘。其余患者未观察到局部复发、转移或大便失禁。
TEM是部分罕见直肠肿瘤的最佳治疗选择。并发症发生率低，治疗效果满意。
