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

摘要： ［摘要］目的 探讨经肛门内镜微创手术（TEM）治疗直肠肿瘤的安全性、疗效及预后，评价其临床应用价值及文献复习。方法 回顾性分析2014年8月至2017年2月期间于佛山市第一人民医院行TEM治疗的45例直肠肿瘤患者的临床资料，总结其临床效果。结果 所有患者的肿瘤病灶均完整切除，肿物直径为1.8±0.8cm（1.0~4.0cm），肿瘤距离肛缘为7.6±2.8cm（6~17cm）；切缘行病理学检查均为阴性，其中全层切除18例，粘膜下及肌层部分切除27例；手术时间为72.7±18.1min（40~120min），术中失血量的中位数为16.6mL（5~200mL）；术后住院时间为4.9±1.7d（4~7d）。术后病理学检查示单纯直肠腺瘤13例，绒毛管状腺瘤13例，腺瘤伴低级别上皮内瘤变5例，腺瘤伴高级别上皮内瘤变7例，腺瘤癌变5例，均为Tis~T1期；另直肠类癌2例。术后发生创面大出血3例，均经保守治疗治愈；5例肛管及内痔损伤出血术中需加缝肛管创面；无大便失禁及肠穿孔情况。39例患者包括5例癌变患者术后常规随访，随访时间的中位数为15个月（2~30个月），随访期间均未出现肿瘤局部复发，未发生大便失禁和排便功能障碍。结论 我们的结果与文献报道结果相近。TEM具有直视下操作、术野暴露清晰、切除范围准确、手术创伤小、复发率低等优点，是一种可用于治疗直肠肿瘤有效的、安全的微创手术方法，应在有条件的医院开展。

关键词: 直肠肿瘤, 经肛门内镜微创手术, 局部切除, 疗效