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首页> 外文期刊>Surgical Endoscopy >Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.
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Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer.

机译：经肛门内窥镜显微手术用于治疗某些直肠癌或可疑癌症的肿瘤。

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BACKGROUND: This study describes a personal experience with the use of transanal endoscopic microsurgery to facilitate surgical access, and to determine the ability of this technique to reduce the need for major abdominal procedure and prevent the need for a temporary or permanent colostomy in select patients with known or suspected rectal cancer. METHODS: The subjects of this study were 43 patients with rectal cancer or tumors who had a high likelihood of malignancy. The 24 men and 19 women comprised two groups: patients with known cancer ( n = 16) and patients with tumors suspicious for cancer ( n = 27), six of whom proved to have invasive malignancy. The tumors ranged in size from 1 to 7 cm (average, 3.5 cm). The tumor's inferior level in the rectum ranged from -1 to 21 cm (average, 6.5 cm). Eleven patients known to have rectal cancer were treated with preoperative radiation or chemoradiation. By ordinary standards, 22 patients would have received an abdominal perineal resection; 14 patients would have qualified for abdominal sphincter-preserving operations; and 7 patients were indeterminate. Full-thickness local excisions were disk excisions ( n = 23), hemicircumferential excisions ( n = 19), and sleeve resection ( n = 1). The ages of the patients ranged from 30 to 91 years (average, 66.7 years). RESULTS: In this study, 90% avoided a major abdominal operation (39/43), and 90% avoided an abdominal perineal resection of the patients (20/22). The complications were as follows: mortality ( n = 10), morbidity ( n = 9), minor wound separation ( n = 6), and major wound separation ( n = 3). Two of these complications were rectovaginal fistulas: the one in a 91-year-old patient who presented with a fistula and the other in a 77-year-old patient who presented with a previously irradiated and incompletely excised cancer. A single instance of locally recurrent cancer required an abdominal perineal resection. There were no other recurrences. Overall, three patients required a stoma (7%). CONCLUSION: Transanal endoscopic microsurgery promises to offer a safe and effective option for the selective treatment of patients with rectal cancer after preoperative chemoirradiation, and for the management of tumors suspicious for rectal cancer. Transanal endoscopic microsurgery used selectively can reduce the need for major abdominal surgery and colostomy.
机译：背景：本研究描述了使用经肛门内窥镜显微外科手术以促进外科手术进入的个人经验，并确定了该技术减少某些大面积腹部手术患者并防止临时或永久结肠造口术的能力。已知或怀疑的直肠癌。方法：本研究的受试者为43例直肠癌或恶性肿瘤可能性高的患者。 24名男性和19名女性分为两组：已知癌症患者（n = 16）和可疑癌症肿瘤患者（n = 27），其中六名被证明具有浸润性恶性肿瘤。肿瘤的大小为1至7厘米（平均3.5厘米）。直肠中肿瘤的下位水平在-1到21厘米（平均6.5厘米）之间。十一名已知患有直肠癌的患者接受了术前放疗或化学放疗。按照普通标准，将有22例患者会阴会阴切除; 14名患者符合保留腹部括约肌手术的资格; 7例患者不确定。全层局部切除为椎间盘切除（n = 23），半周环切除（n = 19）和套管切除（n = 1）。患者的年龄为30至91岁（平均66.7岁）。结果：在这项研究中，有90％的患者避免了大腹部手术（39/43），有90％的患者避免了会阴腹部切除（20/22）。并发症如下：死亡率（n = 10），发病率（n = 9），小伤口分离（n = 6）和大伤口分离（n = 3）。这些并发症中有两个是直肠阴道瘘：一个在91岁患者中出现了瘘管，另一个在77岁患者中出现了先前接受过放射和不完全切除的癌症。局部复发癌的单个实例需要腹部会阴切除。没有其他复发。总体而言，三名患者需要造口（7％）。结论：经肛门内窥镜显微手术有望为术前放化疗后的直肠癌患者进行选择性治疗以及对可疑为直肠癌的肿瘤的治疗提供安全有效的选择。选择性使用经肛门内窥镜显微手术可以减少大腹部手术和结肠造口术的需要。

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