Said S, Huber P, Pichlmaier H
Department of Surgery, University of Cologne, Germany.
Surgery. 1993 Jan;113(1):65-75.
At the Surgical Department of the University of Cologne, a new system has been developed for transanal endoscopic surgery that allows all the conventional surgical techniques within the entire rectal cavity. The method has been in clinical use since 1983. The main indication is the removal of sessile adenomas. Early rectal carcinomas with favorable histologic grading (grades 1 and 2) and staging (Mason I and II) are also suitable for the method. Advanced cancers can also be removed endoscopically in one session, but we perform local excisions of advanced cancers only in cases in which the patient is unwilling to undergo extensive surgery. During the period from July 1983 to December 1990, this method has been employed on 233 patients in 251 cases. The intraoperative and postoperative course of 236 (94%) operations out of 251 was free from any complications. Early postoperative complications consisted of intraperitoneal perforations (five cases), rectovaginal fistulas (four cases), hemorrhages (four cases), and death as a result of cardiopulmonary failure (two cases). The recurrence rate of adenomas is 4.9%. Endorectal surgery allows endoscopic local transanal excision of large adenomas and early cancers with minimal morbidity and excellent presentation of specimens for complete histologic analysis.
在科隆大学外科，已开发出一种用于经肛门内镜手术的新系统，该系统可用于整个直肠腔内的所有传统手术技术。该方法自1983年起开始临床应用。主要适应证为切除无蒂腺瘤。组织学分级良好（1级和2级）且分期合适（梅森I期和II期）的早期直肠癌也适用于该方法。进展期癌症也可在内镜下一次性切除，但我们仅在患者不愿接受广泛手术的情况下对进展期癌症进行局部切除。在1983年7月至1990年12月期间，该方法已应用于233例患者的251例手术中。251例手术中有236例（94%）的术中及术后过程无任何并发症。术后早期并发症包括腹腔内穿孔（5例）、直肠阴道瘘（4例）、出血（4例）以及因心肺衰竭导致的死亡（2例）。腺瘤的复发率为4.9%。直肠内手术可通过内镜经肛门局部切除大腺瘤和早期癌症，发病率极低，且标本呈现良好，便于进行完整的组织学分析。
