| Background:Colorectal cancer is one of common malignant tumor in gastrointestinal tract.According to the 2015 China Cancer Statistics published by the China National Cancer Center,the incidence and mortality of colorectal cancer ranked the fifth in all malignant tumors and showed an upward trend year by year.With the improvement of living standards,the popularization of health knowledge and the improvement of the level of medical examination,the medical examination of digital rectal examination and the application of fiber colonoscopy make the detection rate of benign rectal adenomas,rectal polyps,premalignant colorectal lesions and early rectal malignancies increased year by year.Traditional radical operation result in big trauma,the high incidence of complications.Patients with low rectal tumors have a risk of stoma,and poor quality of life.For early rectal cancer and rectal adenoma,local excision can get satisfactory results.Transanal endoscopic surgery(TEM)as a local resection surgery has its unique advantages.More surgeons prefer to choose TEM for rectal tumors.AIM:To retrospectively summarize the clinical experience of 69 cases of rectal cancer treated with TEM and to explore its application effect.Materials and Methods:Retrospective analyze the clinical data and postoperative follow up date of 69 patients who had undergo transanal endoscopic surgery in Provincial Hospital Affiliated to Shandong University from July 2015 to July 2017.The clinical and pathological characteristics,operation time,postoperative hospital stay,complications,local recurrence rate and other data were analyzed and summarized.Results:69 patients underwent TEM surgery with an average age of 55.6 ± 15.7 years(range,26-83 years),including 33 females and 36 males.Submucosal dissection was performed in 9 patients,while 117 underwent full-thickness resection.The orientations of the lesions at the rectal wall were as follows:29 at the anterior wall,20 at the posterior wall,9 at the left wall,and 11 at the right wall.The average diameter of rectum lesions was 2.6 ± 1.0 cm(range,1.0 cm-5.5 cm).Rectal lesions from the anal edge of the average distance of 5.8 ± 2.2cm(range,4-12cm).Postoperative pathology showed that there were 26 cases of rectal adenoma,including 20 cases of villous tubular adenoma with mild or moderate intraepithelial neoplasia,1 case of villous adenoma,5 cases of tubular adenoma;There were 34 cases of early rectal adenocarcinoma,of which 6 cases were in pTis stage and 28 cases were in pTl stage;One case of advanced rectal cancer in pT2 stage;Neuroendocrine tumors in 4 cases,are G1;rectal stromal tumors in 1 case,high risk;3 cases of rectal inflammatory polyps.Seven patients had complications,perforation,bleeding,venous blood of the lower extremities,urinary retention in 1 case and 3 cases of fever.The average follow-up time was 12(5-29)months without any loss of follow-up.Two cases of rectal cancer patients in pTl stage developed local recurrence.Single-factor analysis of clinical pathological features found that the recurrence was related to tumor size,depth of invasion and intestinal wall involvement in 28 cases pTl rectal cancer patients.Conclusions:1.TEM is a safe and feasible procedure to treat rectal benign adenoma and early rectal cancer and can be used as radical surgery.2.TEM has the advantages of small intraoperative injury,less bleeding,shorter hospital stay,anorectal function can be retained,faster recovery,and can be used as the preferred surgical approach to local resection of rectal lesions3.Although the incidence of complications of TEM surgery is high,most of the complications have self-limiting and little impact on the quality of life of patients... |
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