经肛门内镜微创手术治疗直肠占位的临床体会.docxVIP

经肛门内镜微创手术治疗直肠占位的临 床体会(附53例报告) 封益飞王诗佳张悦吉冰钱文伟季东健张冬生 胥子玮王勇傅赞孙跃明 摘要： 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,其屮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[00 min,平均(42. 8±14. 3) min;术 中出血量545 ml,平均(8.2±4.4) mlo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，术后未发牛腹腔及盆腔感染。木 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例帅部感染、1例直肠创面感染，均保守治疗痊愈。术后住院13 d,平均(4?5±2?6) do术后随访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。 关键词： 直肠疾病;经肛门；内窥镜检查;外科手术，微创性; 作者简介：孙跃明，E-ma订:jssym@vip. sina. com 作者简介：封益飞(1982—)男，南京医科大学第一附属医院结肓肠外科主治医 师，主要从事结直肠外科的研究。 收稿日期：2017-07-18 基金：教育部基金项目(编号:2012YQ030261) Application of transanal endoscopic microsurgery in 53 patients with rectai neoplasms FENG Yi-fei WANG Shi-jia ZHANG Yue Department of Colorectai Surgery, the First Aff订iated Hospital of Nanjing Medical University; Abstract： Objective: To investigate the effect of transanal endoscopic microsurgery (TEM) in the treatment of rectal lesions. Methods: Clinical data of 53 patients with rectal lesions treated by TEM between Feb. 2013 and Dec. 2016 were collected and the effect of TEM in treating rectal lesions was analyzed. Results: All 53 patients were performed TEM successfully. Surgical procedures included the full-thickness excision ( 49 cases) and submucosal and partial muscular excision ( 4 cases) ? The average operation time was ( 42. 8± 14. 3) min ( range 20-100 min) . The mean operative blood loss was ( 8. 2 ± 4. 4) ml ( range 5~45 ml) ? Perforation into the peritoneal cavity occurred in two cases with upper middle anterior wall tumors while full thickness excision was clone by TEM, and closed immediately via laparoscopic suturing without developing peritonitis or pelvic infection. There were no perioperative deaths. Postoperative compl ications were ident/ified in 4 cases ( 7. 5%), in clud ing 1 case of pos to pera tive hemorrhage, 1 case of urinary