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Feasibility of transanal minimally invasive surgery for mid-rectal lesions

机译：经肛门微创手术治疗直肠中段病变的可行性

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Background: Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery. We assessed the feasibility of TAMIS for lesions located in the mid rectum. Methods: From July 2010 to October 2011, 16 consecutive patients with rectal pathology underwent TAMIS. After a single-incision laparoscopic surgery port was introduced into the anal canal, pneumorectum was established with a laparoscopic device, followed by transanal excision with conventional laparoscopic instruments, including graspers, monopolar electrocautery, and needle drivers. Clinicopathological findings, surgical procedure results, and perioperative outcomes were determined prospectively. Results: Of the 16 patients, 11 had rectal cancers (3 T1 lesions and 8 after preoperative chemoradiotherapy), 4 had neuroendocrine tumors, and 1 had a mucocele. The median length of the lesions from anal verge was 7.5 cm (range 4-10 cm). All procedures were completed laparoscopically without conversion to conventional transanal approach. The median operating time was 86 min (range 33-160 min), and the median estimated blood loss was 15 ml (range 0-150 ml) with no patient requiring intraoperative transfusions. There was no surgical morbidity or mortality, but one patient died during follow-up due to synchronous advanced gastric cancer. The median postoperative hospital stay was 3 days (range 2-6 days). Conclusions: TAMIS seems to be a feasible and safe treatment option for lesions located in the mid rectum.
机译：背景：经肛门微创手术（TAMIS）已成为经肛门内镜显微手术的替代方法。我们评估了TAMIS治疗直肠中部病变的可行性。方法：2010年7月至2011年10月，连续16例直肠病理学患者接受TAMIS。将单切口腹腔镜手术口引入肛管后，用腹腔镜装置建立肺脏肿瘤，然后用常规腹腔镜仪器经肛门切除，包括抓紧器，单极电灼和针头驱动器。前瞻性确定临床病理结果，手术结果和围手术期结果。结果：16例患者中，直肠癌11例（T1病变3例，术前放化疗8例），神经内分泌肿瘤4例，黏液囊肿1例。肛门边缘病变的中位长度为7.5 cm（范围4-10 cm）。所有手术均在腹腔镜下完成，无需转换为常规经肛门入路。中位手术时间为86分钟（范围为33-160分钟），中位估计失血量为15毫升（范围为0-150毫升），无患者需要术中输血。没有手术发病率或死亡率，但是有一名患者在随访期间因同步晚期胃癌死亡。术后中位住院时间为3天（范围2-6天）。结论：TAMIS似乎是直肠中部病变的一种可行且安全的治疗选择。

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