CAJ | 학술논문

目的：探讨经肛门内镜显微手术（ TEM）全层切除治疗腹膜返折以上直肠肿瘤的经验。方法回顾性分析采用TEM全层切除治疗的26例腹膜返折以上直肠肿瘤患者的临床资料。结果本组手术均顺利完成，其中1例术中联合腹腔镜下创面缝合，无手术相关死亡。手术时间70～150min，住院时间5～7d。术后无肠瘘，术后发生少量便血2例。腹腔感染1例经抗生素治疗痊愈。术后病理显示了与术前临床评估存在差异。26例（其中2例pT2期的患者追加了腹腔镜Dixon术）均获得随访，随访时间6～72个月，随访发现：术后病理证实为pT1期伴淋巴浸润1例患者，术后6个月时出现肿瘤原发部位复发，余均无复发（包括追加根治性手术的两例pT2期病例）。结论 TEM全层切除腹膜返折上方直肠肿瘤是安全的，同时提供了更详尽的病理信息，并更遵守肿瘤根治原则，值得临床推广。
목적：탐토경항문내경현미수술（ TEM）전층절제치료복막반절이상직장종류적경험。방법회고성분석채용TEM전층절제치료적26례복막반절이상직장종류환자적림상자료。결과본조수술균순리완성，기중1례술중연합복강경하창면봉합，무수술상관사망。수술시간70～150min，주원시간5～7d。술후무장루，술후발생소량편혈2례。복강감염1례경항생소치료전유。술후병리현시료여술전림상평고존재차이。26례（기중2례pT2기적환자추가료복강경Dixon술）균획득수방，수방시간6～72개월，수방발현：술후병리증실위pT1기반림파침윤1례환자，술후6개월시출현종류원발부위복발，여균무복발（포괄추가근치성수술적량례pT2기병례）。결론 TEM전층절제복막반절상방직장종류시안전적，동시제공료경상진적병리신식，병경준수종류근치원칙，치득림상추엄。
Objective To investigate outcomes of the full-thickness excision in the treatment of rectal adenoma and early-stage carcinoma above peritoneal reflection by transanal endoscopic microsurgery ( TEM ) .Methods The clinical data of 26 cases who suffered from rectal adenoma and early-stage carcinoma above peritoneal reflection with TEM full-thickness resections were retrospectively analyzed . Results All of the operations was successfully completed , one of which was combined with laparoscopy surgery for suturing wound ,and there was no operation related death in the 26 cases.Operation time was 70~150 min,and the time of hospitalization was 5~7 d.There was no intestinal leakage after operation ,2 cases occurred a small amount of blood in the stool after operation and 1 case suffered abdominal infection which was cured by antibiotics .Postoperative pathology showed differences from the preoperative clinical assessment.All 26 cases(including 2 cases of pT2 patients with an additional operation of laparoscopic Dixon surgery)were followed up.The follow-up time ranged from 6 to 72 months.During the follow-up time,we found that one case that postoperative pathology confirmed pT 1 stage with lymph node involved the primary tumor site developed recurrence 6 months after operation ,the rest were recurrence free ( including two patients with pT2 stage added to radicalsurgery ) .Conclusion TEM full-thickness resection in treatment of rectal adenoma and early-stage carcinoma above peritoneal reflection is safe ,and provides more detailed pathological information ,and more to comply with en bloc resection of tumor radical principle ,and is worth of the clinical promotion.