Clinical Analysis On Transanal Endoscopic Microsurgery In The Treatment Of Rectal Neoplasms

With the continuous research and innovation in the diagnosis and treatment of rectal tumor,as well as the efficacy of patients for the treatment of disease and postoperative quality of life is increasingly high demand,Minimally invasive and precision medical into clinical work.TEM is a relatively new surgical treatment,not yet completely universal in our country,the surgery can through the anus channel to complete tumor resection,hemostasis,suture operation.compared with the convention-nal transanal local resection,the TEM operation is safe and small,and it can keep the normal function of anal sphincter,and the effect is remarkable,so it is more and more valued and welcomed.Objective:To analyze the clinical effect of transanal endoscopic microsurgery for rectal tumors and evaluate the clinical value.Methods:The clinical data of 66 cases who underwent TEM treatment in the Second Affiliated Hospital of Nanchang University from March 2013 to January 2017 were retrospective studied.The analysis and summary of transanal endoscopic microsurgery in patients with rectal cancer staging,pathological type and tumor size and location,operation time,amount of bleeding,hospitalization time,postoperative complication rate,tumor recurrence rate is completed.Results:66 cases of TEM patients with an average age of 55.9±19.4(19-82)years,with male to female ratio of 44/22,no postoperative death.The average observation period after TEM was 18.1±7.6(2-49)months,the mean operation time:75±45.5 minutes(40-160),the average hospitalization time after operation: 4.6±1.6(1-12)days,the average amount of bleeding during operation:5±3.5(1-30)ml,postoperative bleeding of 2 people(3%),urinary retention in 4 people(6%),the total rate of complications about 9%.The average tumor diameter was 2.5±0.9(0.5-7)cm,and the average distance was about 6.8±1.8(4-16)cm.Adenoma local recurrence rate was 10%,rectal cancer local recurrence rate was 5.8%.Among them,there were 4 cases of precancerous lesion or in situ carcinoma(pTis),7cases of pT1 stageand 5 cases pT2 stage.Patients in the study group were followed up for at least half a year.There was no case of death,and there were a total of 1 patients with rectal cancer recurrence(stage T2),with a total follow-up time of 18 months.Conclusions:TEM has lower complication rate compare with laparoscopic and traditional transanal local resection,has a great advantage of the amount of bleeding,hospitalization time,operation cost,improve the life level of the patients,tumor recurrence rate and long-term survival rate.In the rectal benign disease and early rectal cancer of pTis,pT1 staging and with diameter less than 3cm,TEM is the preferred surgical approach.However,the long term oncologic efficacy of the depth of invasion or pT2 stage and above or the tumor diameter more than 3cm or the poorly differentiated rectal cancer local excision of is still not satisfactory.The patients need selected carefully,and do a good job of the corresponding adjuvant treatment after surgery.