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目的评价经肛门内镜微创手术(TEM)在治疗直肠腺瘤手术中的适应证及临床效果。方法对施行TEM手术治疗的147例直肠腺瘤患者的临床数据进行回顾性分析。结果全组肿瘤平均直径(1.9±0.9)cm,病灶距肛缘的平均距离(7.5±3.0)cm,手术平均用时(60±38)min,术后平均住院时间(6±2)d,术中估计失血量均<10 ml,术后出现发热轻微并发症7例。147例直肠腺瘤均获完整切除,切缘均阴性。术后平均随访(11±2)个月,局部复发3例(6个月内)。结论 TEM可使术野显露良好,切除范围准确,术后恢复快、复发率低,住院时间短,是一种可用于治疗距离肛缘>4 cm且基底较宽腺瘤(<3/4周径)安全有效的微创手术方法。
Objective To evaluate the indications and clinical effects of transanal endoscopic minimally invasive surgery (TEM) in the treatment of rectal adenoma. Methods The clinical data of 147 patients with rectal adenoma undergoing TEM surgery were retrospectively analyzed. Results The average diameter of the tumors was 1.9 ± 0.9 cm and the mean distance from the anal verge was 7.5 ± 3.0 cm. The average time of operation was 60 ± 38 min and the average postoperative hospital stay was 6 ± 2 days. In the estimated amount of blood loss <10 ml, postoperative fever minor complications in 7 cases. 147 cases of rectal adenomas were completely resected, the margins were negative. Postoperative average follow-up (11 ± 2) months, local recurrence in 3 cases (6 months). Conclusion TEM can make the operative field appear well, the scope of resection is accurate, the postoperative recovery is fast, the recurrence rate is low and the hospitalization time is short. It can be used to treat patients with wide basal adenomas (> 3/4 weeks) Path) safe and effective method of minimally invasive surgery.