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经肛门微创外科手术在直肠癌的临床应用 被引量:16

Transanal endoscopic microsurgery for rectal cancer
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摘要 相对于直肠癌根治术而言,直肠癌局部切除术具有手术创伤小、风险低、能保肛以及术后无性功能和泌尿功能障碍等优点。经肛门内镜微创手术(TEM)是近年来国际上较为盛行的一种直肠癌局部切除技术.同传统的局部切除术相比.TEM具有优良的术野显露和宽敞的操作空间,更配有制造精良、性能优越的多种手术器械,为外科医师在术中精细的组织解剖、精准的肿瘤切除、降低和避免肿瘤切缘不足或切缘阳性提供了极佳的手术条件和技术上的保障。术前准确评估、仔细遴选病例以及严格掌握手术指征是获得良好疗效的基础。TEM最佳的适应证为直肠腺瘤高级别瘤变(Tis期)、T1期中低危组直肠癌以及癌仅侵及sm1和sin2的患者。经过新辅助治疗后降期明显(肿块缩小大于50%者)的T,期和L期直肠癌也可进入TEM的研究性治疗。TEM术中对病灶行局部根治性切除是预防肿瘤术后复发的关键。 In comparison with the radical resection for rectal cancer, the local excision of rectal cancer is associated with advantages of less trauma, lower risks, anal sphincter preservation, and sexual and urinary function preservation. Being one of the 10cal excision techniques for rectal cancers, transanal endoscopic microsurgery(TEM) becomes increasingly prevailing worldwide in recent years. As compared to traditional local excision procedures, TEM has been proven to improve the operative exposure and provide more adequate operating space. In addition, the TEM is equipped with multiple well-crafted surgical instruments that offer superior performances, which allows delicate surgical dissection and precise tumor excision. TEM provides surgeons with perfect technical support to decrease the chance of or to preventinsufficient removal of the lesion, which leaves an unsafe or positive surgical margin. Good therapeutic results are based on the accurate preoperative evaluation and careful selection of the patient, as well as strict adherence to the indications of this procedure. The best indications for TEM procedure include rectal adenomas with high-grade dysplasia (Tis stage), medium- or low-risk T1 rectal cancers, and cancers that only infiltrate into the Sml and Sm2 layers of the submucosa. Patients of T2 and T3 rectal cancers acquiring marked tumor downstaging (or tumor size decreases by more than 50% ) after the neoadjuvant therapy may also be candidates for TEM local excision in clinical research studies. TEM technique enables a locally radical excision of the lesion, which is the key to prevent the postoperative recurrence.
作者 邱辉忠
出处 《中华胃肠外科杂志》 CAS 2012年第10期1010-1012,共3页 Chinese Journal of Gastrointestinal Surgery
关键词 经肛门内镜微创手术 直肠肿瘤 早期 术前分期:局部切除术 Transanal endoscopic microsurgery Rectal neoplasms, early Preoperative staging Localexcision
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参考文献14

  • 1Law WL, Chu KW. Anterior resection of rectal cancer withmesorectal excision : a prospective evoluation of 622 patients.Ann Surg, 2004,240(2) :260-268.
  • 2Kaeist W, Junginger T. Residual urine volume after totalmesorectal excision : an indicator of pelvic autonomic nervepreservation? Results of a case-control study. Colorectal Dis,2004,6(6):432-437.
  • 3Shah EF, Huddy SP. A prospective study of genito-urinarydysfunction after surgery for colorectal cancer. Colorectal Dis,2001,3(2):122-125.
  • 4Borschitz T, Heintz A, Junginger T. The influence ofexcised PT1 rectal carcinomas : results of local excision(transanal endoscopic microsurgery) and immediate reoperation.Dis Colon Rectum, 2006,49(10) : 1492-1506.
  • 5Varma MG, Rogers SJ, Sehrock TR, et al. Local excision ofrectal carcinoma. Arch Surg, 1999,134(8):863-867.
  • 6Tytherleigh MG, Warren BF, Mortensen NJ. Management ofrectal cancer. Br J Surg, 2008,95(4) :409-423.
  • 7Dias AR, Nahas CS, Marques CF, et al. Transanal endoscopicmicrosurgery : indication, results and controversies. TechColoproctol, 2009f13(2):105-111.
  • 8Lezoche G, Guerrieri M, Paganini AM, et al. Long-termresults in patients with T2-3N0 distal rectal cancer undergoingradiotherapy before transanal endoscopic mocrosurgery. Br JSurg, 2005,92:1546-1552.
  • 9Lezoche G, Baldarelli M, Guerrieri M, et al. A prospectiverandomized study with a 5-year minimum follow-up evaluationof transanal endoscopic microsurgery versus laparoscopic totalmesorectal excision after neoadjuvant therapy. Surg Endosc,2008,22(2):352-358.
  • 10Lezoche G,Guerrieri M, Baldarelli M,et al. Transanalendoscopic microsurgery for 135 patients with smallnonadvanced low rectal cancer iTl-iT2 iNO) : shorl-and longtermresults. Surg Endosc, 2011,25(4) : 1222-1229.

二级参考文献23

  • 1邱辉忠.经肛门内镜微创手术的临床现状[J].中国实用外科杂志,2007,27(6):446-448. 被引量:8
  • 2Maslekar S,Beral DL,White TJ,et al.Transanal endoscopic microsurgery:where are we now? Dig Surg,2006,23(1-2):12-22.
  • 3de Graaf EJ,Doornebosch PG,Tetteroo GW,et al.Transanal endoscopic microsurgery is feasible for adenomas throughout the entire rectum;a prosoective study.Dis Colon Rectum,2009,52(6):1107-1113.
  • 4Doornebosch PG,Tollenaar RA,De Graaf EJ,et al.Is the increasing role of transanal endoscopic microsurgery in curation for T1 rectal cancer justified? A systematic review.Acta Oncol,2009,48(3):343-353.
  • 5Cataldo PA.Transanal endoscopic microsurgery.Surg Clin North Am,2006,86(4):915-925.
  • 6Lezoche G,Baldarelli M,Guerrieri M,et al.A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy.Surg Endosc,2008,22(2):352-358.
  • 7Zorcolo L,Fantola G,Cadras F,et al.Prospective staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM):comparison of endorectal ultrasound and histopathologic findings.Surg Endosc,2009,23(6):1384-1389.
  • 8Guerrieri M,Baldarelli M,de Sanctis A,et al.Treatment of rectal adenomas by transanal endoscopic microsurgery:15 years' experience.Surg Endosc,2010,24(2):445-449.
  • 9Wilson SE,Gordon HE.Excision of rectal lesions by the Kraske approach.Am J Surg,1969,118(2):213-2l7.
  • 10Mellgren A,Sirivongs P,Rothenberger DA,et al.Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum,2000,43(8):1064-1074.

共引文献11

同被引文献108

  • 1白雪杉,李昀昊,林国乐,周皎琳,牛备战,邱辉忠.经肛门内镜显微手术局部切除早期直肠癌后续治疗策略对临床结局影响研究[J].中国实用外科杂志,2020,40(3):346-352. 被引量:11
  • 2Ming Li Jin Gu.Changing patterns of colorectal cancer in China over a period of 20 years[J].World Journal of Gastroenterology,2005,11(30):4685-4688. 被引量:93
  • 3赫捷,陈万青.2012中国肿瘤登记年报[M].北京:军事医学科学出版社,2012:12-25.
  • 4Dias AR,Nahas CS,Marques CF, et al.transanal endoscopic micro- surgery :indication,results and controversies.Tech Coioproetol, 2009,13(2): 105-111.
  • 5Tytherleigh MG,Warren BF, Mortensen NJ.Management of rectal cancer.Br J Surg,2008,95(4):409-423.
  • 6Kobayashi H, Sugihara K. Surgical management and chemoradiotherapy of T1 rectal cancer [J]. Dig Endosc, 2013, 25 Suppl 2:11-15.
  • 7Lasser P. Local treatments of rectal cancer [J]. J Chit(Paris), 1996,133 : 23-36.
  • 8Prunoiu V, Cirimbei C, Marincas M, et al. Extending indication for radiofrequency ablation (RFA) in cancer surgery[J]. Chirurgia (Bucur), 2011,106 : 585-589.
  • 9Ion D, Stoian RV, P~iduraru DN, et al. Certitudes and controversy regarding neural elements preservation in total mesorectal excision technique (ETM) [J]. Chirurgia (Bucur), 2012,107 : 231-236.
  • 10Kudo S. Endoscopic mucosal resection of flat and depressed types of early eolorectal cancer[J]. Endoscopy, 1993,25:455-461.

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