- 期刊
Transanal Endoscopic Microsurgery for Rectal Tumor: Single Institute Experience in Taiwan
經肛門內視鏡手術於直腸腫瘤的應用：台灣單一醫學中心之經驗
摘要
背景：經肛門內視鏡手術是針對直腸腫瘤的一種局部切除的手術方法，他的優勢在於在內視鏡的協助下，運用特殊的器材精確的切除直腸腫瘤，以達到更廣的安全切除範圍，本文為探討本院運用這種手術方式處理直腸腫瘤短期的結果以及長期的追蹤資料。病人與方法：自2004年10月到2010年8月，有42個直腸腫瘤患者接受經肛門內視鏡手術，我們前瞻性的紀錄了這些患者的短期的手術復原資料、併發症、長期局部復發以及遠端轉移的臨床資料。結果：我們針對所有的直腸腫瘤做全層的完整切除，腫瘤平均距離肛門齒狀線10公分，平均腫瘤大小為2.2公分，有36%腫瘤為惡性的，他們局部分期均為T1～T2，另外三分之二的腫瘤是良性的。平均術後的住院天數為2.6天，沒有任何病人有長期的大便失禁的情形。平均追蹤期間是2.4年，在良性的腫瘤有1人（3.6%）有局部的復發，惡性腫瘤則無，也沒有任何的遠端轉移或者是手術後的死亡。結論：經肛門內視鏡手術是針對直腸腫瘤局部切除的好工具，可以妥善處理直腸的任何良性腫瘤，以及部分的早期惡性腫瘤。
並列摘要
Purpose. Transanal endoscopic microsurgery (TEM) is a minimally invasive local excision for rectal benign and malignant neoplasm. It provides good optic view and precise excision of rectal neoplasm with safe margin. The study showed our experience of operative short-term results, and long-term oncologic outcome.Methods. From 2004/10 to 2010/8, 42 patients who had undergone TEM by a single surgeon were included. Short-term peri-operative recovery, complications, local recurrence and systemic metastatic rates were prospectively recorded.Results. All operations were performed using full-thickness excision by TEM equipment. The median height was located 10 cm above the dentate line (4~20 cm) and the median size of the tumor was 2.2 cm (0.6~5.4 cm). 36% lesions were T1 and T2 carcinomas, and 64% were benign tumors. The median post-operative stay was 2.6 days. No patient experienced long-lasting fecal soilage. With the mean follow-up of 2.4 years, the local recurrence rate was 3.7% for benign tumors, and 0% for malignant cancers. Neither systemic metastasis nor peri-operative mortality were noted.Conclusions. TEM is an excellent, safe local treatment and less invasive procedure for benign rectal tumors in any location of the rectum and distal sigmoid. It is also an alternative choice for rectal malignancy with low probability of lymph node metastasis.
延伸閱讀
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