经肛内镜显微外科手术_TEM医学医药

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1、Treatmentofrectaladenomasbytransanalendoscopicmicrosurgery(TEM):15years’experienceSurgEndosc.2009姜海军Backgroundpresentexperiencewithrectaladenomasmanagedbytransanalendoscopicmicrosurgery(TEM).Goal:evaluatingmorbidity,mortality,andlocalrecurrencerate.PatientsandmethodsEnrolled:402patients,pr

2、eoperativediagnosisofadenomas.(1993.1-2008.10)Meanage:65years(range22-92)Men:221vsWomen:181distanceofadenomasfromtheanalverge0-3cm:28patients3-6cm:58patients6-12cm:251patients12-16cm:54patients>16cm:11patientsLesionpositionanteriorwalloftherectum:92patientsposteriorwall:107patientslateralwall

3、:88patientssemicircumferential:98patientscircumferential:17patientsPreoperativetherapystagingdigitalexaminationtoevaluatetumorfixationtotalcolonoscopyrigidrectoscopy:macrobiopsies;measurethedistancefromtheanalverge;determinethelocationandconsequentlyselectthepositiontransanalendosonography(EU

4、S)byarotativeprobecomputedtomography(CT)scanormagneticresonanceimaging(MRI):giantandsuspectedlesionsPatientpreparationwashoutofthecolonshort-termantibioticprophylaxisgeneralanesthesiainthemajorityofpatientsSpinalanesthesiawasusedin65(16.1%)high-riskpatients(ASA4).1.supineposition2.proneposit

5、ion3.lateralpositionplacethelesionintheinferiorpartoftheoperativefieldFullthicknessexcision:379patients(94.3%)1cmminimumofnormalmucosaaroundthelesionMucosectomy:23patients(5.7%)Meanoperativetimewas64min(range=22–120).rectaldefectwasclosed:endoluminalrunningsuturewithasilverclipplacedateache

6、ndofthesuturetoavoidanintrarectalnode.only15patients(3.7%)requiredtherepeatedadministrationofketorolac30mginthefirst48h.drinkliquidsonthefirstpostoperativedayMeanhospitalstaywas2.5days(range=1–8days).short-termresults:Minimalintraoperativecomplications:13casesanopeningoftheperitonealcavityand

7、in1patienttherewasanopeningofthevaginaAlllesionswereclosedendoscopicallybyTEMwithoutanyintra-orpostoperativeconsequences.giantadenomas(2cases):impossibletocarryoutacompletesuture.temporaryileostomyclosedafter2monthsOneofthetwopatientshadarect