CAJ | 학술논문

目的探讨经肛门内镜微创手术(TEM)治疗直肠肿瘤的临床疗效.方法回顾性分析2012年11月至2014年3月南昌大学第二附属医院收治的35例直肠肿瘤患者临床资料.患者术前行经直肠腔内超声(ERUS)检查评估局部浸润与淋巴转移情况,确定肿瘤的病理学类型、大小、位置、浸润深度以及肠壁周围有无肿大淋巴结,施行TEM.采用门诊、电话或微信等方式进行随访,随访时间截至2014年8月.结果肿瘤位于直肠前壁者6例,后壁者11例,左侧及右侧壁者各9例;肿瘤直径为(2.3±0.9)cm(0.7～4.8 cm),肿瘤下缘距离肛缘为(8±4)cm(4～17 cm).术中出血量为(32±19)mL(5 ～60 mL),手术时间为(79 ±35)min(31 ～ 150 min).术中标本切缘1例阳性,及时补充切除后,切缘阴性.35例患者术后均未行特殊镇痛处理,术后1～3d进流质食物,肛门排气后出院,住院时间为(4.2±1.2)d(2.0～9.0d).术后病理学检查证实为直肠腺瘤12例、原位癌(Tis期)2例、直肠类癌2例、低危T1期直肠癌9例、高危T1期直肠癌7例、T2期直肠癌3例.3例术后病理学检查证实为T2期直肠癌患者接受化疗.术后17例患者发生并发症,其中9例为会阴坠胀、排便频繁,4例为肛门括约肌功能损伤,2例为急性尿潴留,2例为轻度渗血,均经对症治疗缓解.35例患者随访时间为5 ～22个月,平均随访为11个月.直肠癌复发率为2/19,其中低、高危T1期直肠癌复发率为1/16,T2期直肠癌复发率为1/3.接受新辅助治疗患者中无复发,12例未接受新辅助患者中有2例复发.结论 TEM是一种治疗直肠腺瘤、原位癌、直肠类癌及早期低危、高危T1期直肠癌安全、有效的手术方法.
목적 탐토경항문내경미창수술(TEM)치료직장종류적림상료효.방법 회고성분석2012년11월지2014년3월남창대학제이부속의원수치적35례직장종류환자림상자료.환자술전행경직장강내초성(ERUS)검사평고국부침윤여림파전이정황,학정종류적병이학류형、대소、위치、침윤심도이급장벽주위유무종대림파결,시행TEM.채용문진、전화혹미신등방식진행수방,수방시간절지2014년8월.결과 종류위우직장전벽자6례,후벽자11례,좌측급우측벽자각9례;종류직경위(2.3±0.9)cm(0.7～4.8 cm),종류하연거리항연위(8±4)cm(4～17 cm).술중출혈량위(32±19)mL(5 ～60 mL),수술시간위(79 ±35)min(31 ～ 150 min).술중표본절연1례양성,급시보충절제후,절연음성.35례환자술후균미행특수진통처리,술후1～3d진류질식물,항문배기후출원,주원시간위(4.2±1.2)d(2.0～9.0d).술후병이학검사증실위직장선류12례、원위암(Tis기)2례、직장유암2례、저위T1기직장암9례、고위T1기직장암7례、T2기직장암3례.3례술후병이학검사증실위T2기직장암환자접수화료.술후17례환자발생병발증,기중9례위회음추창、배편빈번,4례위항문괄약기공능손상,2례위급성뇨저류,2례위경도삼혈,균경대증치료완해.35례환자수방시간위5 ～22개월,평균수방위11개월.직장암복발솔위2/19,기중저、고위T1기직장암복발솔위1/16,T2기직장암복발솔위1/3.접수신보조치료환자중무복발,12례미접수신보조환자중유2례복발.결론 TEM시일충치료직장선류、원위암、직장유암급조기저위、고위T1기직장암안전、유효적수술방법.
Objective To explore the clinical efficacy of transanal endoscopic microsurgery (TEM) for the rectal tumor.Methods The clinical data of 35 patients with rectal tumors who were admitted to the Second Affiliated Hospital of Nanchang University between November 2012 and March 2014 were retrospectively analyzed.The preoperative endorectal ultrasonography (ERUS) was applied to patients for evaluating local invasion and lymph node metastasis,and confirming the pathological types of tumors,size and location of tumors,depth of invasion and with or without lymph node enlargement around the rectal wall,and then patients underwent TEMs.Patients were followed up by outpatient examination,telephone interview and instant messenger (WeChat) till August 2014.Results The tumors of 6 patients were located in the anterior wall of rectum,11 were in the posterior wall of rectum,9 were in the left and 9 in the right side walls of rectum.The diameter of tumor,distances between distal margin of tumor and anal verge,volume of intraoperative blood loss and operation time were (2.3 ± 0.9) cm (range,0.7-4.8 cm),(8 ±4)cm(range,4-17 cm),(32 ±19)mL (range,5-60 mL) and (79 ±35)minutes (range,31-150 minutes),respectively.Tumors with positive margin showed the negative margin after supplementary resection.All the patients didn't receive the specific analgesic therapy with the intake of liquid diets at postoperative day 1-3,and they were discharged after anal exsufflation.The duration of hospital stay was (4.2 ±1.2)days (range,2.0-9.0 days).The results of pathological examination showed that rectal adenoma were detected in 12 patients,rectal carcinoma in situ in 2 patients (Tis stage),rectal carcinoid in 2 patients,low-risk T1 stage of rectal cancer in 9 patients,high-risk T1 stage in 7 patients and T2 stage in 3 patients who received chemotherapy.Seventeen patients had postoperative complications,including 9 with perineum swelling and frequent defecation,4 with functional impairment of anal sphincter,2 with acute urinary retention and 2 with mild errhysis with the eased symptoms after symptomatic treatment.A total of 35 patients were followed up for 5-22 months with a median time of 11 months.The recurrence rate of rectal cancer was 2/19,including in the low-and high-risk T1 stage of 1/16 and in T2 stage of 1/3.Two of 12 patients without adjuvant therapy had recurrence of tumors,and other patients had no recurrence of tumors after adjuvant therapy.Conclusion TEM is safe and feasible in the treatment of rectal adenoma,carcinoma in situ,rectal carcinoid as well as rectal cancer in the low-and high-risk T1 stage.