目的探讨经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)治疗直肠肿瘤的疗效及预后,评价其临床应用价值。方法回顾性分析2012年8月至2014年11月期间于青岛大学附属医院行TEM治疗的26例直肠肿瘤患者的临床资料,总结其临床效果。结果所有患者的肿瘤病灶均完整切除,切缘行病理学检查均为阴性。手术时间为(70.7±22.1)min(40~120 min),术中失血量的中位数为9.8 m L(5~30 m L);术后住院时间为(5.4±2.2)d(4~9 d)。术后病理学检查示单纯直肠腺瘤12例,腺瘤伴低级别上皮内瘤变8例,腺瘤伴高级别上皮内瘤变2例,腺瘤局灶癌变2例,均为T 1期;直肠类癌2例。术后发生大便带血1例,一过性大便失禁2例。26例患者术后均获访,随访时间的中位数为9个月(6~18个月)。随访期间均未出现肿瘤局部复发,未发生控便和排便功能障碍。结论 TEM的术野暴露良好、切除范围准确、术后恢复快、复发率低,是一种可用于治疗直肠肿瘤,特别是位于直肠中上段的良性肿瘤及早期直肠癌的安全而有效的微创手术方法。 Objective To investigate the efficacy and prognosis of transanal endoscopic microsurgery (TEM) for the treatment of rectal tumors and evaluate its clinical value. Methods The clinical data of 26 patients with rectal cancer treated with TEM at Qingdao University Affiliated Hospital from August 2012 to November 2014 were analyzed retrospectively to summarize their clinical effects. Results All patients had complete resection of the tumor lesions. The pathological examination of the margins was negative. The operative time was (70.7 ± 22.1) min (40-120 min) and the median blood loss was 9.8 m L (5-30 m L). The postoperative hospital stay was (5.4 ± 2.2) days (4 ~ 9 d). Postoperative pathological examination showed 12 cases of pure rectum adenoma, adenoma with low-grade intraepithelial neoplasia in 8 cases, adenoma with high-grade intraepithelial neoplasia in 2 cases, adenoma 2 cases of focal canceration, were T1 ; Rectal carcinoid in 2 cases. Postoperative stool bloody in 1 case, transient incontinence in 2 cases. Twenty-six patients were followed up, with a median follow-up of 9 months (range, 6-18 months). During the follow-up period, no local tumor recurrence occurred and no defecation and defecation dysfunction occurred. Conclusions TEM is a safe and effective minimally invasive method for the treatment of rectal tumors, especially benign tumors located in the upper and middle rectum and early rectal cancer with good surgical field exposure, accurate resection range, rapid postoperative recovery and low recurrence rate. Surgical methods.