Lirici M M, Chiavellati L, Lezoche E, Martelli S, Melotti G, Morino M, Guerrieri M, Selmi I, Stipa S, Angelini L
4th Department of General Surgery, University of Rome, La Sapienza, Italy.
Endosc Surg Allied Technol. 1994 Oct;2(5):255-8.
The Italian experience with Transanal Endoscopic Microsurgery (TEM) started in 1991. Until April, 1994, 122 patients were operated on by such a technique in six centres. The surgical protocol in the 66 patients with benign lesions was similar to that described by Buess. In contrast to the German experience, the indications of TEM for cancer have been extended to more advanced tumours and in 22 out of 56 patients with rectal carcinoma adjuvant radiation- or radiation-chemotherapy have been applied according to various protocols. In 88% of TEM for rectal tumours the operation has been carried out according to a full-thickness technique, with or without perirectal fat excision. Postoperative morbidity of TEM for adenoma was 15.8% and that of TEM for carcinoma 29.6%. There was no postoperative mortality. Local recurrence rate after TEM for adenoma was 10.5%, while that after TEM for cancer was 9.25%. No local recurrence has been reported among patients treated with a combination of TEM and adjuvant radiation treatments. The median follow-up in the 6 centres ranged between 7 and 16 months. A randomised prospective clinical trial has been planned in order to evaluate the role of transanal endoscopic microsurgery in the treatment of locally advanced rectal cancer.
意大利经肛门内镜显微手术（TEM）的经验始于1991年。截至1994年4月，六个中心共有122例患者接受了该技术手术。66例良性病变患者的手术方案与布伊斯所描述的相似。与德国的经验不同，TEM治疗癌症的适应证已扩展至更晚期肿瘤，56例直肠癌患者中有22例根据不同方案接受了辅助放疗或放化疗。在88%的直肠肿瘤TEM手术中，采用了全层技术，有或没有切除直肠周围脂肪。腺瘤TEM术后发病率为15.8%，癌TEM术后发病率为29.6%。无术后死亡病例。腺瘤TEM术后局部复发率为10.5%，癌TEM术后局部复发率为9.25%。在接受TEM与辅助放疗联合治疗的患者中，未报告局部复发情况。六个中心的中位随访时间为7至16个月。已计划开展一项随机前瞻性临床试验，以评估经肛门内镜显微手术在治疗局部晚期直肠癌中的作用。
