Feasibility Analysis And Therapeutic Evaluation Of Transanal Endoscopic Microsurgery For The Treatment Of Rectal Masses

At this stage,surgical resection is the main treatment for rectal tumors.To determine the surgical procedures with considering the patient’s condition,the nature of the tumor and the location of the tumor,such as local excision of various approaches,traditional rectal tumor radical surgery,various improved Resection and deciding whether to use radiotherapy or chemotherapy before or after surgery.Among them,the benign tumor of the lower rectum is treated with local resection,which can basically meet the clinical requirements for complete resection.However,due to the limitations of the site and local resection of the upper and middle rectal tumors,local resection is not routinely used as a treatment.In recent years,due to the improvement of the diagnosis of early rectal tumors and the standardization and rationalization of preoperative pathological staging,the progress and popularization of minimally invasive techniques for colorectal cancer surgery,and the widespread acceptance of minimally invasive concepts have led to the gradual generalization and regularization of local resection of rectal tumors.Among them,transanal endoscopic microsurgery as an important part of local resection has gradually entered the public eye.On the one hand,compared with conventional local rectal tumor resection,the scope of TEM surgery is larger,besides the tumor can be removed more completely.Thus,avoiding the residual tumor and surgical field can be enlarged,the cutting margin can be better exposed,and the operation can stop bleeding.The suture is more precise,which greatly avoids the narrowing of the intestinal lumen.And the complications such as intraoperative and postoperative bleeding caused by damage to the blood vessels around the tumor during the operation.On the other hand,traditional rectal tumor radical surgery has a large scope of surgery,and it is easy to damage the postoperative pain caused by surrounding tissues and blood vessels during surgery,the incidence of complications such as postoperative bleeding is high,and nerve damage may occur during surgery.It can cause the patient’s defecation and fertility function to be affected.In addition,the larger surgery will lead to prolonged time required forpostoperative recovery,and the hospitalization cost and family burden will be relatively increased.TEM surgery is a good way to avoid the appeal shortcomings.If the case can be strictly selected,some patients with rectal cancer undergo TEM surgery.And the postoperative survival rate can be the same with the rate of traditional radical surgery.Patients can have a better quality of life.Therefore,transanal endoscopic microsurgery is gradually understand and accepted by the public.Objective: To retrospectively analyze a series of clinical data of patients with rectal cancer undergoing TEM surgery and to explore its efficacy and feasibility.Methods: The clinical data of 136 patients with rectal tumors treated by transanal endoscopic microsurgery admitted to the Second Affiliated Hospital of Nanchang University from November 2015 to November 2018,such as tumor diameter,the distance from the lower edge of the tumor to the anal margin,postoperative fasting time,postoperative hospital stay,intraoperative blood loss,postoperative pathology and staging,postoperative complications and tumor recurrence rate.And those were reviewed and summarized.Results: The age of 136 patients undergoing anal endoscopic microsurgery was57.3±12.9(24-83)years old,male to female ratio: 78/58,The tumor diameter was2.25 ± 1.21(0.3-6)cm.The lower edge of the tumor was 5.93±2.31(4-20)cm from the anal margin.The intraoperative blood loss was 10.94±37.4(0-400)ml.The post-fasting time was 1.49±0.63(0-3)days,and the postoperative hospital stay was4.83±3.36(1-36)days.There were 3 patients with postoperative blood in the stool,1patient with rectal anastomotic leakage,and 4 patients with urinary retention.And the total complication rate was 5.9%.The recurrence rate of patients with benign tumors was 3.28%;and the recurrence rate of rectal cancer patients was 7.1%,:6 patients with rectal cancer in situ,5 patients with pT1,and 2 patients with PT2,No recurrence during follow-up.One patient with PT4 had a local tumor recurrence and liver metastasis at the 13 th month of follow-up.The postoperative follow-up period ranged from three mouths to 3 years,the average follow-up time is 14 months,and no deaths occurred.Conclusion: TEM surgery is effective,safe and effective for rectal benigntumors and early rectal cancer,which is worth promoting.