PURPOSE:Transanal endoscopic microsurgery (TEM) is a technique that has found its place in routine practice due to its minimal invasive character and associated low morbidity. The purpose of this study was to assess the influence of anatomical variables of rectal neoplasms as well as surgeon experience on postoperative complications in patients undergoing TEM at a tertiary care center. METHODS:Data from 288 patients undergoing TEM over a 16 year period were entered in a prospective data base. Anatomical data of rectal neoplasms, operative data, and early postoperative outcome were analyzed retrospectively. RESULTS:Overall surgical complications [OR 7.0 (1.5-45,5); p < 0.01] and bleeding [OR 222 (82 - 14316); p < 0.01] correlated with the localization of the neoplasm on the lateral wall of the rectum. Furthermore there was a trend for more surgical overall complications as well as bleeding in neoplasms with a diameter of >2 cm and neoplasms located >8 cm from the anal verge. Complications did not correlate with the number of TEM procedures performed. CONCLUSION:TEM resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding. The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery.

译文

目的:经肛门内镜显微外科手术(TEM)由于其微创特征和较低的发病率而在常规实践中占有一席之地。这项研究的目的是评估在三级护理中心进行TEM的患者中直肠肿瘤的解剖变量以及外科医生经验对术后并发症的影响。
方法:将前瞻性数据库中输入来自288名在16年内接受TEM的患者的数据。回顾性分析直肠肿瘤的解剖学数据,手术数据和术后早期结局。
结果:总体手术并发症[OR 7.0(1.5-45,5); p <0.01]和出血[OR 222(82-14316); p <0.01]与肿瘤在直肠侧壁上的定位有关。此外,直径> 2 cm的肿瘤和距肛门边缘> 8 cm的肿瘤有更多的外科手术总体并发症以及出血的趋势。并发症与所执行的TEM手术数量无关。
结论:直肠外侧壁肿瘤的TEM切除有较高的出血风险。经肛门内镜显微外科手术的学习曲线在具有微创手术经验的外科医生看来可以忽略不计。

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