Kilic Ali, Sisik Abdullah
Ann Ital Chir. 2018;89:177-181.
One of the minimally invasive methods used in the surgical treatment of large-based polypoid lesions located in the rectum is transanal minimally invasive surgery (TAMIS). This method, which relieves patients from the severe morbidities of invasive surgical procedures, is performed in both malign (T1-T2) and benign lesions. Difficulty of suturation after TAMIS emerges as the most important factor to prolong the procedure. We aimed to analyse the efficacy of TAMIS procedure with partial thickness resection without suturation.
This was a retrospective study. The study was conducted in a Turkish Education and Research Hospital in 2016. Data of 10 patients who diagnosed with benign rectal masses were included in the study. Patients who were suspected for muscularis propria invasion and lymph node positivity in magnetic resonance imaging preoperatively excluded from the study. All lesions were resected with TAMIS and the mucosal defects were not closed in any patients. Demographic features, lesion's distances to anal verge, excised lesion's size, histopathological report, operation times, duration of hospital stay and complications were recorded RESULTS: Six male and 4 female patients were treated. The mean distance to the anal werge of the lesions was 8.5 (5-12) cm. The longest diameters of the lesions ranged from 1-4 cm in length. All the patients were discharged the day after the surgery. Operation times were found to be 46.1 ± 5 min (30-70). Histopathological examinations of the removed lesions revealed villous adenomas in 3 patients, villous adenoma and Tis adenocarcinoma in 5 patients, villous adenoma and T1 adenocarcinoma in 1 patient and neuroendocrine tumor in 1 patient. There were no early complications such as bleeding, and late complications such as perforation, anal incontinence or anorectal dysfunction in any patient. No evidence of recurrence was found in any of the patients under control rectosigmoidoscopy and pelvic MRI examinations.
Partial thickness resection of rectal benign lesions by TAMIS method is safe. After resection some surgeons suggest to close the defect by suture or stapler. In our study resection without closure of the defect is found safe and feasible with limited patient prejudice.
Rectal benign lesions, Transanal partial thickness excision.
经肛门微创手术（TAMIS）是用于治疗直肠广基息肉样病变的微创手术方法之一。该方法可使患者免于侵入性手术的严重并发症，可用于治疗恶性（T1-T2）和良性病变。TAMIS术后缝合困难是延长手术时间的最重要因素。我们旨在分析不缝合的部分厚度切除术在TAMIS手术中的疗效。
这是一项回顾性研究。该研究于2016年在一家土耳其教育和研究医院进行。研究纳入了10例诊断为直肠良性肿物的患者。术前磁共振成像怀疑有肌层浸润和淋巴结阳性的患者被排除在研究之外。所有病变均采用TAMIS切除，所有患者的黏膜缺损均未封闭。记录患者的人口统计学特征、病变距肛缘的距离、切除病变的大小、组织病理学报告、手术时间、住院时间和并发症。
治疗了6例男性和4例女性患者。病变距肛缘的平均距离为8.5（5-12）cm。病变的最长直径为1-4 cm。所有患者均在术后第一天出院。手术时间为46.1±5分钟（30-70分钟）。切除病变的组织病理学检查显示，3例患者为绒毛状腺瘤，5例患者为绒毛状腺瘤和Tis腺癌，1例患者为绒毛状腺瘤和T1腺癌，1例患者为神经内分泌肿瘤。所有患者均未出现出血等早期并发症，也未出现穿孔、肛门失禁或肛门直肠功能障碍等晚期并发症。在直肠乙状结肠镜检查和盆腔MRI检查中，未发现任何患者有复发迹象。
采用TAMIS方法对直肠良性病变进行部分厚度切除是安全的。切除后，一些外科医生建议用缝线或吻合器封闭缺损。在我们的研究中，不封闭缺损的切除被发现是安全可行的，对患者的不利影响有限。
直肠良性病变；经肛门部分厚度切除术
