Management of large malignant rectal polyps with transanal endoscopic microsurgery. Is there anything better for the patient?

L Chiavellati, G D'Elia, M Zerilli, S Tremiterra, S Stipa
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Abstract

The authors report their experience with transanal endoscopic microsurgery (TEM), a technique that allows all the standard surgical manoeuvres such as tissue excision, suction, control of bleeding and suturing in the entire length of the rectal cavity. Main indications for TEM are the removal of large sessile polyps and early rectal cancers' (T1, G1-G2). Out of 50 patients submitted to TEM the authors consider in this study 24 cases with a preoperative diagnosis of benign large sessile polyps. The procedures included: 14 (58.3%) total wall excision, four (16.6%) total wall excision with perirectal fat, three (12.5%) mucosectomy, one mucosectomy + total wall excision, one partial wall excision + total wall excision, and the remaining case was converted to laparotomy due to a large intraperitoneal perforation. There was no operative mortality and an 8.3% rate of major complications. With a median follow up of 19 months there was no evidence of local or distant recurrence. The authors compare their results with those of alternative endoscopic and surgical techniques and highlight the advantages of TEM in the management of large and giant rectal polyps.

经肛门内镜显微手术治疗直肠大型恶性息肉。有更好的治疗方法吗?
作者报告了他们在经肛门内窥镜显微手术(TEM)方面的经验,这项技术允许所有标准的手术操作,如组织切除、抽吸、控制出血和在整个直肠腔内缝合。TEM的主要适应症是切除大的无根息肉和早期直肠癌(T1, G1-G2)。在50例接受TEM检查的患者中,作者在本研究中考虑了24例术前诊断为良性大无柄息肉。手术包括:14例(58.3%)全肠壁切除术,4例(16.6%)全肠壁切除伴直肠周围脂肪切除术,3例(12.5%)粘膜切除术,1例粘膜切除术+全肠壁切除术,1例部分肠壁切除术+全肠壁切除术,其余1例因腹腔内穿孔较大而转为开腹手术。无手术死亡,主要并发症发生率为8.3%。中位随访19个月,没有发现局部或远处复发的证据。作者将他们的结果与其他内窥镜和手术技术的结果进行了比较,并强调了TEM在治疗大型和巨型直肠息肉中的优势。
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