经肛内镜显微外科手术TEM医学医药.pptxVIP

经肛内镜显微外科手术TEM医学医药第1页/共30页 Treatment of rectal adenomas by transanal endoscopic microsurgery(TEM):15 years’experience第2页/共30页 Backgroundpresent experience with rectal adenomas managed by transanal endoscopic microsurgery(TEM).Goal:evaluating morbidity, mortality, and local recurrence rate.第3页/共30页 Patients and methodsEnrolled:402 patients, preoperative diagnosis of adenomas.(1993.1-2008.10)Mean age:65 years(range22-92)Men:221 vs Women:181第4页/共30页 distance of adenomas from the anal verge0-3 cm: 28 patients3-6 cm: 58 patients6-12 cm: 251 patients12-16 cm: 54 patients 16 cm: 11 patients第5页/共30页 Lesion positionanterior wall of the rectum:92 patientsposterior wall:107 patientslateral wall:88 patientssemicircumferential:98 patientscircumferential:17 patients第6页/共30页 Preoperative therapy stagingdigital examination to evaluate tumor fixationtotal colonoscopyrigid rectoscopy:macrobiopsies; measure the distance from the anal verge; determine the location and consequently select the position第7页/共30页 transanal endosonography (EUS) by a rotative probecomputed tomography (CT) scan or magnetic resonance imaging (MRI):giant and suspected lesions第8页/共30页 Patient preparationwashout of the colonshort-term antibiotic prophylaxisgeneral anesthesia in the majority of patientsSpinal anesthesia was used in 65 (16.1%) high-risk patients(ASA 4).第9页/共30页 1.supine position2.prone position 3.lateral positionplace the lesion in the inferior part ofthe operative field第10页/共30页 Fullthickness excision: 379 patients (94.3%) 1 cm minimum of normal mucosa around the lesionMucosectomy: 23 patients(5.7%)第11页/共30页 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.第12页/共30页 only 15 patients (3.7%) required the repeated administration of ketorolac 30 mg in the first 48 h.drink liquids on the first postoperative dayMean