经肛内镜显微外科手术tem医学医药.pptxVIP

Treatment of rectal adenomas by transanal endoscopic microsurgery(TEM):15 years’experience;Background;Patients and methods;distance of adenomas from the anal verge;Lesion position;Preoperative therapy staging;transanal endosonography (EUS) by a rotative probe computed tomography (CT) scan or magnetic resonance imaging (MRI):giant and suspected lesions;Patient preparation; 1.supine position2.prone position 3.lateral position;Fullthickness excision: 379 patients (94.3%) 1 cm minimum of normal mucosa around the lesion Mucosectomy: 23 patients(5.7%) ;Mean operative time was 64 min (range = 22–120). rectal defect was closed: endoluminal running suture with a silver clip placed at each end of the suture to avoid an intrarectal node. ;only 15 patients (3.7%) required the repeated administration of ketorolac 30 mg in the first 48 h. drink liquids on the first postoperative day Mean hospital stay was 2.5 days (range = 1–8 days). ;short-term results:;giant adenomas(2 cases):impossible to carry out a complete suture. temporary ileostomy closed after 2 months One of the two patients had a rectal stenosis required endoscopic dilatation. At follow-up of 24 and 30 months (the patient with rectal stenosis) no other complications were observed.;Definitive histology;Postoperative follow-up;complications;All leaking sutures resolved by local therapy (antibiotics and analgesic enema) and/or parenteral nutrition. Stool incontinence was treated with physiotherapy and anal sphincter biofeedback resolved within 2 months of the operation The patients with hemorrhaging, two of them with cirrhosis, required blood transfusions;Surgical drainage and colostomy (patient is alive after 1 year) Laparoscopic ileostomy and a new suture by TEM.(patient is alive after 2 years without other complications);Long-term results;No patients had a new recurrence at the next follow-up Of the 34 patients with pT1 rectal cancer, the mean follow-up of 30 months (range = 14–