经肛内镜显微外科术_TEM医学医药.pptVIP

Treatment of rectal adenomas by transanal endoscopic microsurgery(TEM):15 years’experience Surg Endosc.2009 姜海军 Background present experience with rectal adenomas managed by transanal endoscopic microsurgery(TEM). Goal:evaluating morbidity, mortality, and local recurrence rate. Patients and methods Enrolled:402 patients, preoperative diagnosis of adenomas.(1993.1-2008.10) Mean age:65 years(range22-92) Men:221 vs Women:181 distance of adenomas from the anal verge 0-3 cm: 28 patients 3-6 cm: 58 patients 6-12 cm: 251 patients 12-16 cm: 54 patients 16 cm: 11 patients Lesion position anterior wall of the rectum:92 patients posterior wall:107 patients lateral wall:88 patients semicircumferential:98 patients circumferential:17 patients Preoperative therapy staging digital examination to evaluate tumor fixation total colonoscopy rigid rectoscopy:macrobiopsies; measure the distance from the anal verge; determine the location and consequently select the position transanal endosonography (EUS) by a rotative probe computed tomography (CT) scan or magnetic resonance imaging (MRI):giant and suspected lesions Patient preparation washout of the colon short-term antibiotic prophylaxis general anesthesia in the majority of patients Spinal anesthesia was used in 65 (16.1%) high-risk patients(ASA 4). 1.supine position2.prone position 3.lateral position Mean operative time was 64 min (range = 22–120). rectal defect was closed: endoluminal running suture with a silver clip placed at each end of the suture to avoid an intrarectal node. short-term results: Minimal intraoperative complications: 13 cases an opening of the peritoneal cavity and in 1 patient there was an opening of the vagina All lesions were closed endoscopically by TEM without any intra- or postoperative consequences. giant adenomas(2 cases):impossible to carry out a complete suture. temporary ileostomy closed after 2 months One of t