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目的:探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠占位性病变的应用效果。方法:总结2013年2月至2016年12月接受TEM治疗的53例直肠占位患者的临床资料,分析TEM在直肠占位性病变治疗中的应用效果。结果:本组53例均成功施行TEM,其中49例行直肠壁全层切除,4例行黏膜下及肌层部分切除。手术时间20~100 min,平均(42.8±14.3)min;术中出血量5~45 ml,平均(8.2±4.4)ml。术中2例中上段直肠前壁肿瘤行全层切除时切入腹腔,立即行腹腔镜下一期修补成功,术后未发生腹腔及盆腔感染。本组均无围手术期死亡病例,术后4例(7.5%)发生并发症,其中1例术后出血、1例尿潴留、1例肺部感染、1例直肠创面感染,均保守治疗痊愈。术后住院1~13 d,平均(4.5±2.6)d。术后随访5~52个月,平均(23.4±7.3)个月,均未发现肿瘤复发、转移及控便、排便功能障碍。结论:TEM是安全的,其微创性、疗效均优于传统经肛直肠肿瘤切除术,可作为适合局部切除直肠病灶的首选治疗方法。
Objective: To investigate the effect of transanal endoscopic microsurgery (TEM) in the treatment of rectal space-occupying lesions. Methods: The clinical data of 53 cases of rectal space-occupying patients treated with TEM from February 2013 to December 2016 were summarized, and the application of TEM in the treatment of rectal space-occupying lesions was analyzed. Results: TEM was successfully performed in 53 cases of this group, of which 49 cases underwent resection of the wall of the rectal wall and partial resection of the submucosa and muscularis in 4 cases. The operation time ranged from 20 to 100 minutes (mean, 42.8 ± 14.3) min. The intraoperative blood loss was from 5 to 45 ml (mean, 8.2 ± 4.4) ml. Intraoperative 2 cases of upper rectal wall tumors cut into the abdominal cavity when the full-thickness resection immediately laparoscopic repair a success, no postoperative abdominal and pelvic infection. There were no perioperative deaths in this group. Complications were found in 4 cases (7.5%) after operation, including 1 case of postoperative bleeding, 1 case of urinary retention, 1 case of lung infection and 1 case of rectal wound infection. . Postoperative hospital stay 1 ~ 13 d, an average of (4.5 ± 2.6) d. The patients were followed up for 5 to 52 months with an average of (23.4 ± 7.3) months. No tumor recurrence, metastasis, defecation and defecation dysfunction were found. CONCLUSION: TEM is safe, and its minimal invasiveness and curative effect are superior to the traditional anorectal tumor resection, which can be used as the preferred treatment for local resection of rectal lesions.