The Clinical Research Of The Method Of Transanal Endoscopic Rectal Tumor Resection

Objective: Discuss the clinical application method of TEM(Transanal Endoscopic Microsurgery)in the rectal tumor operation.Methods: Patients with rectal neoplasm during hospitalization in gastrointestinal surgery during from 2013 October to 2015 March in Shenzhen People’s Hospital,choose the 18 patients who received TEM treatment as the research group(TEM Group).Choose the 9 ones who received laparoscopic radical surgery for rectal neoplasm during from 2012 May to 2013 October as the control group(TME Group).Operation time,intraoperative blood loss,postoperative exhaust time, complication rates,hospital stays and hospital expenses from from the two groups were collected and compared.Observe the function and effect of TEM in the partial resection of rectal benign and early malignant lesions.Discuss TEM surgical skills and the related factors influencing the TEM operation effect.Result: The results are as follows:1,there was no statistically significant difference in age(P=0.56),gender(P=1.00),distance of tumor from the anal verge(P=0.37)and tumor diameter(P=0.66) between the two groups patients.Two group’s patients have clinical comparability;2,There were significant differences in operation time(P=0.000),intraoperative blood loss(P=0.000),postoperative exhaust time(P=0.000), hospital stays(P=0.000), hospital expenses(P=0.000).The differences had obviously statistical significance.The datas from TEM Group were less than TME Group.There was no statistically significant difference in complication rates(P=0.67);3,TEM group: The diameter of the lesion was 1.5-2.0cm,and mean was(1.86±0.23)cm.9 patients’ operations were successfully completed by endoscopic surgery and the others were completed by looking straightly.13 patients were resected with full-thickness and 5 ones were resected with submucosal layer.The edge and bases of tumor were negative according the fast icy cross-section during operation. 7 patients had complications and the occurrence rate was 38.9%.No patients had local recurrence accosding 2-17 month follow-ups.Conclusion: 1,The TEM is suitable for the lump which is 4-15 cm from the anus and diameter less than 2.0 cm:wide base or rectal benign adenomas,early rectal cancer,and other rectal neoplasm,such as carcinoid, stromal tumor etc;2,It is aiso suitable for the weak and old patients who can not tolerate major surgery and have rectal local lesions with bieeding.3,It is suggested that the TME was suitable for rectal lesion larger than 2.5 cm in diameter;4,It can be gradually mastered through the system training although TEM operation has certain difficulty.