Shaltiel Tali, Gingold-Belfer Rachel, Kirshtein Boris, Issa Nidal
Department of Surgery, Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel.
Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
J Minim Access Surg. 2023 Apr-Jun;19(2):282-287. doi: 10.4103/jmas.jmas_147_22.
Local excision of large rectal polyps can be an alternative for radical rectal resection with total mesorectal excision. We aim to report the functional and oncological outcomes of transanal endoscopic microsurgery (TEM) for patients with large rectal polyps.
All demographic and clinical data of patients who underwent TEM for rectal polyp of 5 cm or more at the Hasharon Hospital from 2005 to 2018 were retrospectively reviewed.
Twenty-eight patients were included. The mean age was 66 years. The mean polyp size was 6.2 cm (range: 5-8.5 cm) with a mean distance of 8.3 cm from the anal verge. Peritoneal entry during TEM was observed in five patients and additional laparoscopy after the completion of the TEM was performed in four patients. There were no major perioperative complications. Seven patients had minor complications. Final pathology revealed T1 carcinoma in five patients and T2 carcinoma in three patients. Re-TEM was performed in one patient with involved margins with adenoma. After a median follow-up of 64 months, one patient had local recurrence.
TEM is an acceptable technique for the treatment of large polyps with minor complications and a reasonable recurrence rate. TEM may be considered regardless of the size of the rectal polyp.
对于大型直肠息肉，局部切除可作为全直肠系膜切除根治性直肠切除术的替代方法。我们旨在报告经肛门内镜显微手术（TEM）治疗大型直肠息肉患者的功能和肿瘤学结局。
回顾性分析2005年至2018年在哈沙龙医院接受TEM治疗直肠息肉直径达5厘米及以上患者的所有人口统计学和临床数据。
纳入28例患者。平均年龄66岁。息肉平均大小为6.2厘米（范围：5 - 8.5厘米），距肛缘平均距离为8.3厘米。5例患者在TEM过程中出现腹膜穿孔，4例患者在TEM完成后进行了额外的腹腔镜检查。无围手术期重大并发症。7例患者出现轻微并发症。最终病理显示5例为T1期癌，3例为T2期癌。1例切缘累及腺瘤的患者进行了再次TEM。中位随访64个月后，1例患者出现局部复发。
TEM是治疗大型息肉的一种可接受的技术，并发症轻微，复发率合理。无论直肠息肉大小，均可考虑采用TEM。
