关键词: 直肠肿瘤, 经肛门内镜微创手术, 局部切除, 疗效

Abstract: ［Abstract］ Objective To investigate the clinical value of transanal endoscopic microsurgery（TEM） and review literature. Methods The clinical data of 45 patients with rectal lesions treated using TEM between Aug. 2014 and Feb. 2017 were summarized retrospectively. Results All 45 patients were performed TEM successfully. The lesions were 1.8 ± 0.8 cm（range, 1.0?4.0 cm）in diameter, and the distance of the anastomosis from the anal verge was 7.6 ± 2.8 cm（range, 6?17 cm）. Surgical procedures included the full?thickness excision（18 cases）and the submucosal excision with partial muscular layer excision（27 cases）. The average operating time was 72.7 ± 18.1 min（40?120 min）. The mean operative blood loss was 16.6 mL（range, 5?200 mL）. The average postoperative stay was 4.9 ± 1.7 d（4?7 d）. The postoperative pathological examination identified rectal adenomas in 18 cases, villous adenoma in 13, high grade intraepithelial neoplasia in 7, early rectal adenocarcinomas（Tis?T1）in 5, rectal carcinoid in 2. Surgical margins of all specimens were clear. Postoperative complications included wound hemorrhage in 3 cases who were cured conservatively, anal hemorrhage of internal hemorrhoids and anal canal injury in 5 who were sutured. No patient was encopresis and enterobrosis. The incidence of complications was 6.7%（3/45）. With a mean follow?up period of 15 months（2?30 months）, no abnormal defecation, no tumor recurrence and metastasis was observed. Conclusion Our outcomes are in line with the literature. The localized rectal neoplasms suitable for local excision are the main indications of TEM. TEM is a safe and effective procedure to treat rectal cancer in selected patients such as Tis?T1, and T2 is not recommended because of a higher recurrence rate. As a kind of minimally invasive surgery with fewer complications, TEM is now considered as the first choice of procedure for rectal local excision.

Key words: rectal neoplasms, local excision, transanal endoscopic microsurgery（TEM）, prognosis