Serra-Aracil Xavier, Lucas-Guerrero Victoria, Mora-López Laura
Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
Clin Colon Rectal Surg. 2022 Feb 28;35(2):129-134. doi: 10.1055/s-0041-1742113. eCollection 2022 Mar.
Transanal endoscopic microsurgery (TEM) allows the local excision of rectal tumors and achieves lower morbidity and mortality rates than total mesorectal excision. TEM can treat lesions up to 18 to 20 cm from the anal verge, obtaining good oncological results in T1 stage cancers and preserving sphincter function. TEM is technically demanding. Large lesions (>5 cm), those with high risk of perforation into the peritoneal cavity, those in the upper rectum or the rectosigmoid junction, and those in the anal canal are specially challenging. Primary suture after peritoneal perforation during TEM is safe and it does not necessarily require the creation of a protective stoma. We recommend closing the wall defect in all cases to avoid the risk of inadvertent perforation. It is important to identify these complex lesions promptly to transfer them to reference centers. This article summarizes complex procedures in TEM.
经肛门内镜显微手术（TEM）可对直肠肿瘤进行局部切除，与全直肠系膜切除术相比，其发病率和死亡率更低。TEM 可治疗距肛缘达 18 至 20 厘米的病变，在 T1 期癌症中能取得良好的肿瘤学效果，并保留括约肌功能。TEM 在技术上要求较高。大的病变（>5 厘米）、有较高腹腔穿孔风险的病变、直肠上段或直肠乙状结肠交界处的病变以及肛管内的病变尤其具有挑战性。TEM 术中腹膜穿孔后的一期缝合是安全的，不一定需要造保护性造口。我们建议在所有病例中封闭肠壁缺损以避免意外穿孔的风险。及时识别这些复杂病变并将其转诊至参考中心很重要。本文总结了 TEM 中的复杂操作。
