经肛门内镜显微手术治疗直肠肿瘤64例临床分析  

Analysis of Clinical Material of Transanal Endoscopic Microsurgery in the Treatment for 64 Patients with Rectal Tumors

作　　者：黄永建[1] 叶建新[1] 庄金福[1] 陈绍勤[1] 郑炜[1] 杨树钢[1] 

机构地区：[1]福建医科大学附属第一医院胃肠外科,福州350005

出　　处：《福建医科大学学报》2012年第5期335-336,共2页Journal of Fujian Medical University

基　　金：福建省科技计划项目(2012D014)

摘　　要：目的探讨经肛门内镜显微外科手术(TEM)治疗直肠肿瘤的疗效。方法回顾分析TEM治疗64例直肠肿瘤患者的临床资料。结果肿瘤病灶位于直肠后壁者21例、右侧壁者17例、前壁10例、左侧壁16例,肿瘤直径(2.16±0.84)cm(0.6～4.2cm),病灶距离肛缘(9.6±3.62)cm(4～18cm)。患者均采用TEM治疗,手术时间(82.24±39.08)min(28～190min),术中失血量(31.76±21.22)mL(5～80mL),术后病理检查为直肠腺瘤38例、直肠癌22例(Tis 9例,T1 9例,T2 4例)、直肠类癌4例。所有标本切缘均阴性。术后4例发生并发症,对症处理治愈。64例患者随访平均13月(3～25月),其中1例患者局部复发。结论 TEM切除精确,术中损伤小,术后恢复快,是直肠肿瘤个体化治疗的手术方式之一,但术前病例选择很重要。Objective To evaluate transanal endoscopic microsurgery（TEM） for the treatment of rectal tumors.Methods Clinical data of 64 patients with rectal tumors treated by TEM between November 2011 and December 2012 were collected and analyzed retrospectively.Results 21 lesions were located on the posterior wall of the rectum,17 on the right wall,10 on the anterior wall and 16 on the left wall.The mean diameter of rectal lesions was（2.16±0.84）（range from 0.6 to 4.2） cm.The average distance of lesions from the anal verge was（9.6±3.62）（range from 4 to 18）cm.The average operating time was（82.24±39.08）（range from 28 to 190）min.The mean operative blood loss was（31.76±21.22）（range from 5 to 80）mL.The postoperative pathological examination identified 38 rectal adenomas,22 rectal adenocarcinomas（9 cases of Tis,9 T1,4 T2）,4 rectal carcinoids.Surgical margins of all specimens were negative.Follow-UP checkups in the 64 patients for mean 13 months（range from 3 to 25 months） revealed 1 case local recurrence.Conclusions TEM shows advantages of accurate excision with small hurt and fast recovery,which is one of the operation methods for individual rectal tumors therapy,but it is very important to select appropriate patient for TEM.

关 键 词：肛管 内窥镜检查 直肠肿瘤 显微外科手术 

分 类 号：R735.3[医药卫生—肿瘤]