探讨经肛门内镜下手术治疗直肠腺瘤和早期直肠癌的疗效。

2011年6月至2012年6月，在吉林大学第二医院行TEM治疗的直肠肿瘤患者21例。全麻下根据肿瘤位置选择合适的体位，经肛门插入特殊的手术直肠镜，保持CO₂充气状态，在立体视镜和腔镜系统辅助下，采用针形电刀或5 mm超声刀将直肠肿瘤完整切除(黏膜下或全层切除)，在腔内连续缝合手术创口。

21例直肠肿瘤患者均获完整切除，术中快速病理确定切缘均阴性。手术时间45～160 min，平均90 min；术中出血量0～60 ml，平均15 ml。手术并发症：发热5例，急性尿潴留1例，因长期服用阿司匹林出血2例。术后病理分期：T₀期11例，Tis期5例，T₁期3例，T₂期2例。21例均随访12个月，肿瘤无原位复发及远处转移。

TEM是治疗直肠腺瘤和早期直肠癌的一种安全、有效的微创手术方法。

To investigate outcomes of transanal endoscopic microsurgery(TEM)for the treatment of rectal adenoma and early-stage rectal carcinoma.

Twenty-one patients with rectal tumors underwent TEM from June 2011 to June 2012.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO₂ insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments, the tumor was completely resected(submucosal or full-thickness excision)using a needle diathermy or a 5-mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures.

The rectal tumor was completely removed with negative resection margins in all the 21 patients.The operating time was 45~160 min(mean, 90 min)and the intraoperative blood loss was 0~60 ml(mean, 15 ml). Complications included fever in 5 patients, acute retention of urine in 1 patient, and secondary hemorrhage following Aspirin taking in 2 patients.The postoperative pathological stages were T₀ in 11 patients, Tis in 5 patients, T₁ in 3, and T₂ in 2.Follow-up checkups in the 21 patients until now revealed no local recurrence and distant metastasis.

TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal adenoma and early rectal carcinoma.