三种局部切除术对直肠腺瘤性息肉的治疗研究
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摘要
直肠腺瘤性息肉（rectal adenomatous polypus）已被询证医学证实为直肠癌前病变。规范合理的治疗直肠腺瘤性息肉，通过手术切除防止癌变，是降低直肠癌发病率的最佳方案。
目前常用的直肠腺瘤性息肉的手术切除方法主要包括内镜息肉切除术，经肛门内镜下显微外科手术和经肛息肉局部切除术。在临床治疗中，三种术式的适应症和禁忌症基本相似且无统一的选择指南；现有文献中尚缺乏对三种术式的比较研究。
为了探讨三种手术方法的疗效、并发症及手术、住院时间、医疗费用的不同，寻找出疗效较佳、并发症较少、对患者创伤较少且使患者经济负担较小的根治方法。本研究回顾性收集了2009年-2011年间于吉林大学第一、二、三院行内镜息肉切除术，经肛门内镜下显微外科手术及经肛息肉局部切除术的直肠腺瘤性息肉患者的临床资料，对三组术式患者的手术疗效，术中术后并发症的发生率，平均手术、住院时间及住院总费用等进行了比较研究。
经统计分析，内镜息肉切除术、经肛门内镜下显微外科手术、经肛息肉局部切除术均能有效切除直肠腺瘤性息肉，切除成功率较高；内镜微创治疗术能切除距肛周距离较远的息肉；其术中的并发症较经肛息肉局部切除术少；平均手术时间、平均住院时间较TEM术及经肛息肉局部切除术短；手术总费用较TEM术和经肛息肉局部切除术少。
通过本研究，全面对比分析了临床现用的三种直肠腺瘤性息肉的手术方法，为医务工作者和患者科学、理性的选择有效、安全、经济的治疗方法提供专业信息和参考。
Introduction:Rectal adenomatous polypus has been demonstrated as the one of rectal precancerous diseases by a large number of clinical studies. In accordance with the theory of "adenoma-carcinoma" sequence and correlative evidence based medicine, the rate of rectal carcinoma can be reduced by the resection of rectal adenoma. The main surgical local resections include endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection. Generally speaking, there is lack of the contrastive research for surgical effect, complications and the cost among the three manners although their indications and contraindications are approximately similar. My study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies from No.l, No.2and No.3hospital attached to the Jilin University in the past two years. And it makes a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the cost totally.
Objective:Through statistical analysis, a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the total cost could show pros and cons of the three therapies in an objective point of view. Depending on it, maybe we can establish a standardization for the local resectional therapy of rectal adenomatous polypus.
Materials and Methods:This study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies (endoscopic resection, transanal endoscopic microsurgery and transanal local resection) from the No.l, No.2and No.3hospital attached to the Jilin University in the past two years (2009-2011). The samples can be classified into three groups based on the different surgical therapies, and in the followed text we call them endoscopic group, TEM group and transanal group for abbreviation. Each group has65. Statistically analyze the three groups of patients by the common information (age> gender), basic adenomatous data before operation (distance between tumor and anus> diameter of tumor and pathological classification), effect of operation (success rate> rate of complications), average time of surgery or being in bed and the total cost.
Results:We can see that, in the common information, there is no statistical significant difference in distribution of age and gender among the three groups (P>0.05). In the basic adenomatous data before operation, there is no statistical significant difference in distribution of tumor's pathological classification and tumor's diameter among the three groups (P>0.05), and the difference of distance from adenoma to anus between the endoscopic group and the transanal group has statistical significance (P=0.005). The distance in endoscopic group is upper than the transanal group. And the difference has no statistical significance in other groups (P>0.05). From the comparison of success rate of different resectional manners, it shows that there is no statistical significant difference among the three groups (P>0.05). The comparison of intraoperative complications indicates that the difference of intraoperative bleeding between the transanal group and the endoscopic group has statistical significance (P=0.015). The bleeding in the transanal group is more than the endoscopic group. And the difference has no statistical significance in other groups (P>0.05). There is no intraoperative perforation in all the three groups. And the difference of rate of postoperative bleeding and perforation has no statistical significance among the three methods. Through the statistical analysis of average operative time of the three local resections, the endoscopic group took the less time than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average operative time between the TEM group and transanal group. In the comparison of average time of being in hospital, time in endoscopic group is less than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average time of being in hospital between the TEM group and transanal group. Finally, we take a comparison of total cost among the three local resectional methods, and it shows that the endoscopic group costs less than the other groups. The difference has statistical significance (P<0.001)
Conclusion:Endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection, all of the three methods could make an effective resection upon the samples who have the diagnosis of rectal adenomatous polypus. And the success rate of them is high. However, we also see the advantages of the endoscopic resection through the correlative statistical analysis. Endoscopic resection can treat with the adenoma which is more far from anus and has less intraoperative bleeding. The average time of operation and being in hospital in the endoscopic group is the least of all, and the cost for treatment is also the least.
目前常用的直肠腺瘤性息肉的手术切除方法主要包括内镜息肉切除术，经肛门内镜下显微外科手术和经肛息肉局部切除术。在临床治疗中，三种术式的适应症和禁忌症基本相似且无统一的选择指南；现有文献中尚缺乏对三种术式的比较研究。
为了探讨三种手术方法的疗效、并发症及手术、住院时间、医疗费用的不同，寻找出疗效较佳、并发症较少、对患者创伤较少且使患者经济负担较小的根治方法。本研究回顾性收集了2009年-2011年间于吉林大学第一、二、三院行内镜息肉切除术，经肛门内镜下显微外科手术及经肛息肉局部切除术的直肠腺瘤性息肉患者的临床资料，对三组术式患者的手术疗效，术中术后并发症的发生率，平均手术、住院时间及住院总费用等进行了比较研究。
经统计分析，内镜息肉切除术、经肛门内镜下显微外科手术、经肛息肉局部切除术均能有效切除直肠腺瘤性息肉，切除成功率较高；内镜微创治疗术能切除距肛周距离较远的息肉；其术中的并发症较经肛息肉局部切除术少；平均手术时间、平均住院时间较TEM术及经肛息肉局部切除术短；手术总费用较TEM术和经肛息肉局部切除术少。
通过本研究，全面对比分析了临床现用的三种直肠腺瘤性息肉的手术方法，为医务工作者和患者科学、理性的选择有效、安全、经济的治疗方法提供专业信息和参考。
Introduction:Rectal adenomatous polypus has been demonstrated as the one of rectal precancerous diseases by a large number of clinical studies. In accordance with the theory of "adenoma-carcinoma" sequence and correlative evidence based medicine, the rate of rectal carcinoma can be reduced by the resection of rectal adenoma. The main surgical local resections include endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection. Generally speaking, there is lack of the contrastive research for surgical effect, complications and the cost among the three manners although their indications and contraindications are approximately similar. My study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies from No.l, No.2and No.3hospital attached to the Jilin University in the past two years. And it makes a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the cost totally.
Objective:Through statistical analysis, a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the total cost could show pros and cons of the three therapies in an objective point of view. Depending on it, maybe we can establish a standardization for the local resectional therapy of rectal adenomatous polypus.
Materials and Methods:This study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies (endoscopic resection, transanal endoscopic microsurgery and transanal local resection) from the No.l, No.2and No.3hospital attached to the Jilin University in the past two years (2009-2011). The samples can be classified into three groups based on the different surgical therapies, and in the followed text we call them endoscopic group, TEM group and transanal group for abbreviation. Each group has65. Statistically analyze the three groups of patients by the common information (age> gender), basic adenomatous data before operation (distance between tumor and anus> diameter of tumor and pathological classification), effect of operation (success rate> rate of complications), average time of surgery or being in bed and the total cost.
Results:We can see that, in the common information, there is no statistical significant difference in distribution of age and gender among the three groups (P>0.05). In the basic adenomatous data before operation, there is no statistical significant difference in distribution of tumor's pathological classification and tumor's diameter among the three groups (P>0.05), and the difference of distance from adenoma to anus between the endoscopic group and the transanal group has statistical significance (P=0.005). The distance in endoscopic group is upper than the transanal group. And the difference has no statistical significance in other groups (P>0.05). From the comparison of success rate of different resectional manners, it shows that there is no statistical significant difference among the three groups (P>0.05). The comparison of intraoperative complications indicates that the difference of intraoperative bleeding between the transanal group and the endoscopic group has statistical significance (P=0.015). The bleeding in the transanal group is more than the endoscopic group. And the difference has no statistical significance in other groups (P>0.05). There is no intraoperative perforation in all the three groups. And the difference of rate of postoperative bleeding and perforation has no statistical significance among the three methods. Through the statistical analysis of average operative time of the three local resections, the endoscopic group took the less time than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average operative time between the TEM group and transanal group. In the comparison of average time of being in hospital, time in endoscopic group is less than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average time of being in hospital between the TEM group and transanal group. Finally, we take a comparison of total cost among the three local resectional methods, and it shows that the endoscopic group costs less than the other groups. The difference has statistical significance (P<0.001)
Conclusion:Endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection, all of the three methods could make an effective resection upon the samples who have the diagnosis of rectal adenomatous polypus. And the success rate of them is high. However, we also see the advantages of the endoscopic resection through the correlative statistical analysis. Endoscopic resection can treat with the adenoma which is more far from anus and has less intraoperative bleeding. The average time of operation and being in hospital in the endoscopic group is the least of all, and the cost for treatment is also the least.
引文
[1]Muto T,Bussey H J R,Morson B C. The evolution of cancer of the colon and rectum[J].Cancer,1975,36(6):2251-2270.
[2]来茂德.WHO新的结直肠肿瘤分类的特点[J].中华病理学杂志.2003,32(2)：170-172
[3]Chan AT, Giovannucci EL, M eyerhard t JA, et al.Asp inin dose and Duration of use and risk of colorectal cancer in men[J]. Gastroenterology,2008,134(1)21-28.
[4]Oh K, Willett WC, Wu K, et al. Calcium and vitam in relation to risk of distal colorectal adenoma in women[J]. Am J Ep idemio,12007,165(10):265-269.
[5]Abhirojn S, John H, John R.T. Monson. Local excision of rectal tumours[J]. Surgical Oncology,2003Elsevier Science.
[6]刘宝善.直肠癌局部切除术[J].中国普外基础与临床杂志,2004,1：82—84.
[7]林国乐,邱辉忠,吴斌,等Mason手术在中下段直肠癌局部切除术中的应用价值[J].癌症进展杂志,2004,2(6)：426—429.
[8]韩少良,邵永孚.早期直肠癌局部治疗方法的选择[J].实用肿瘤杂志,2001,16(1)：71—73.
[9]厉军,王朝明,王蓓Kraske手术在直肠癌局部切除术中的应用[J].实用肿瘤杂志,2003,18(4)：318—319
[10]Balani A, Turoldo A, Bralni A, et al.local excision for rectalcancer[J]. J Surg Oncol,2000,74(2):158
[11]王奇,直肠腺瘤经骶尾部入路切除术的应用价值[J].西部医学杂志,2009,21(8)：08-1317-02
[12]魏法才,杨风辉,隋永领,等.经阴道后壁直肠肿瘤局部切除术附27例报告[J].肿瘤防治杂志,2001,8(21)：361—362.
[13]韩少良,王海鹏,花亚伟,等.低位直肠肿瘤局部外科治疗[J].肿瘤2003,23(3)：248—249.
[14]许炳华,经肛门内镜下直肠肿瘤显微手术[J].国外医学外科学分册 2003,30(6)：326-329
[15]Demartines N, et al.Transanal endoscopic microsurgical excision of rectal tumors:Indications and results[J].World J Surg2001;25(7):870-875.
[16]Winde G, et al. Surgical cure for early rectal carcinomas (Tl). Transanal endoscopic microsurgery vs. anterior resection[J]. Dis Colon Rectum1996,39(9):969-976
[17]Visser BC, et al. Local therapy for rectal cancer[J]. Surg Oncol.2001,10(1-2):61-69.
[18]蒙家兴,林国乐,刘应裕,等.经肛门内镜显微手术治疗直肠绒毛状腺瘤和早期直肠癌31例[J].中国微创外科杂志,2006,1(6)：15-18.
[19]但汉雷,张亚历.小肠功能障碍与衰竭的诊断和评分[J].世界华人消化杂志,2002,10(10)：1197—1200
[20]Guerrieri M, et al. Treatment of rectal adenomas by transanal endoscopic microsurgery:15years'experience[J].Surg Endosc.2010,24(12):445-449
[21]邱辉忠,林国乐,肖毅,吴斌.经肛门内镜微创手术治疗直肠肿瘤120例[J].协和医学杂志.2011,2(1)：33-36
[22]刘波,夏立健,于海华,陈景波,杨明宇,李凯等.经肛门内镜微创手术治疗直肠肿瘤的手术经验[J].中国微创外科杂志.2011,11(3)：240-242
[23]林国乐,邱辉忠,,蒙家兴,等.经肛门内镜显微手术在直肠肿瘤局部切除术中的应用[J].中国现代手术学杂志,2006,5(10)：334-337.
[24]Nadine DF,Theodore JS.Transanal endoscopic microsurgical resection of pTl rectal tumors[J].Dis Colon Rectum,2005,49(1):164-168.
[25]蒙家兴,邵初晓,刘应裕,等.经肛门内镜显微手术切除直肠肿瘤[J].中华胃肠外科杂志,2003,3(6)：96-98.
[26]李建国.结直肠腺瘤性息肉诊治新进展[J].国际病理科学与临床杂志,2011,31(2)：150-154
[27]Dehle P,Largiader F,Jenny S,et al.A method for endoscopic lectroresection of sessile colonic polyps.Endoscopy,1973,5:38-40.
[28]Lightdale CJ. Endoscopicmucosal resection:This is our turf [J]. Endoscopy2004,36(9):808-810.
[29]王伟,李兆申.内镜治疗胃肠道早期肿瘤的新理念、新技术[J].中华消化内镜杂 志,2009,9：986-991.
[30]Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract-Hook knife EMR method[J]. Min.Invas. Ther. Allied Technol2002;11:291-295.
[31]Oh YS, E arly DS, A zar RR. C lin ical appl icat ion s of endoscopic ultrasound to on cology [J]. On cology,2005,68(4-6):526-537.
[32]Peters FP, Kara MA, Rosmolen WD,et al. Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus[J]. Gastrointest Endosc,2005,6(l):506-514.
[33]Kantsevoy SV,Adler DG,et al.Endoscopic mucosal resection and endoscopic submucosal dissection [J]. Gastrointest Endosc,2008,6(8):11-18
[34]Oda I,Gotoda T,Hamanaka H,et al.Endoscopic submucosal dissection for early gastric cancer:technical feasibility,operation time and complications from a large consecutive series[J]. Dig Endosc,2005,17:54-58
[35]姚礼庆,钟芸诗.内镜黏膜下剥离术在中低位直肠肿瘤中的应用[J]中国实用外科杂志.2009,29(4)
[36]孙爱武,张奕萌,鲁志诚,等.内镜下黏膜切除术在消化道肿瘤中的应用[J].中国内镜杂志,2005,11：1075-1077.
[37]Kakushima N and Fujishiro M. Endoscopic submucosal dissection for gastrointestinal neoplasms [J]. World J Gastroenterol,2008,14(19):2962-2967.
[38]Gotoda T,et al.Endoscopic submucosal dissection of early gastric cancer[J].J Gastroenterol,2006,41(10):929-942.
[39]Fujishiro M, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms[J].Endoscopy,2006,38(10):1001-1006
[40]Lieberman D.Rectal bleeding and diminutive colon polyps[J]. Gastroenterology.2004:126:1167-1174
[41]Chiu YS,Spencer RJ.Villous lesions of the colon[J].Dis Colon Rectum,1978,21:493-495.
[42]Buess G,Mentges B,Manncke K,Starlinger M, Becker HD. Technique and results of transanal endoscopic microsurgery in early rectal cancer[J]. Am J Surg1992;163:63
[43]KS. Transanal endoscopic microsurgery. Initial registry results[J].Dis Colon Rectum1996;39:S79-84
[44]Adam IJ, Shorthouse AJ. Outcome following transanal endoscopic Microsurgery [J]. Dis Colon Rectum1998;41:526-527
[45]顾红,田雨,李美星,李会,王嶙。内镜下黏膜切除术在结直肠腺瘤治疗中的应用[J].现代中西医结合杂志.2011,20(9)：1051-1053
[46]Maslekar S, Beral DK, White T J, et al. Transanal endoscipic Microsurgery:where are we now?[J] Dig Surg,2006,23(1-2):12-22
[47]赵刚,肖刚,周新平,余涛,杨华,黄美雄.经肛门内镜微创手术治疗直肠肿瘤[J].腹腔镜外科杂志.2010.15(6)：421-424
[48]Paty PB, Nash GM, Baron P, et al. Long-term results of localexcision for rectal cancer[J]. Ann Surg,2002,236(4):522-529
[49]Sutton CD, Marshall LJ, White SA, et al. Ten-year experience of endoscopic transanal resection[J]. Ann Surg,2002,235(3):355-562
[50]夏立建,直肠肿瘤局部切除治疗进展[J].中国肿瘤临床.2006.33(22)：1312-1315
[51]Yoshida N, Yagi N, Naito Y, et al. Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing [J]. World J Gastroenterol,2010,16(14):1688-1695
[52]Kaltenbach T, Soetikno R.Endoscopic mucosal resection of nonpolypoid colorectal neoplasm [J]. Gastroin test Endosc Clin N Am,2010,20(3):503-514
[53]Saito Y, Matsuda T, Fujii T. Endoscopic submucosal dissection of nonpolypoid colorectal neoplasms[J]. Gastroin test Endosc C lin N Am,2010,20(3):515-524
[54]Baik SH, Kwon HY, Kim JS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer:short-term outcome of a prospective comparative study [J]. Ann Surg Oncol,2009,16(6):1480-1487.
[55]Patel CB, Ramos-Valadez DI, Haas EM. Robotic-assisted laparoscopic abdominoperineal resection for anal cancer:feasibility and technical considerations [j]. Int J Med Robot,2010,6(4):399-404.
[2]来茂德.WHO新的结直肠肿瘤分类的特点[J].中华病理学杂志.2003,32(2)：170-172
[3]Chan AT, Giovannucci EL, M eyerhard t JA, et al.Asp inin dose and Duration of use and risk of colorectal cancer in men[J]. Gastroenterology,2008,134(1)21-28.
[4]Oh K, Willett WC, Wu K, et al. Calcium and vitam in relation to risk of distal colorectal adenoma in women[J]. Am J Ep idemio,12007,165(10):265-269.
[5]Abhirojn S, John H, John R.T. Monson. Local excision of rectal tumours[J]. Surgical Oncology,2003Elsevier Science.
[6]刘宝善.直肠癌局部切除术[J].中国普外基础与临床杂志,2004,1：82—84.
[7]林国乐,邱辉忠,吴斌,等Mason手术在中下段直肠癌局部切除术中的应用价值[J].癌症进展杂志,2004,2(6)：426—429.
[8]韩少良,邵永孚.早期直肠癌局部治疗方法的选择[J].实用肿瘤杂志,2001,16(1)：71—73.
[9]厉军,王朝明,王蓓Kraske手术在直肠癌局部切除术中的应用[J].实用肿瘤杂志,2003,18(4)：318—319
[10]Balani A, Turoldo A, Bralni A, et al.local excision for rectalcancer[J]. J Surg Oncol,2000,74(2):158
[11]王奇,直肠腺瘤经骶尾部入路切除术的应用价值[J].西部医学杂志,2009,21(8)：08-1317-02
[12]魏法才,杨风辉,隋永领,等.经阴道后壁直肠肿瘤局部切除术附27例报告[J].肿瘤防治杂志,2001,8(21)：361—362.
[13]韩少良,王海鹏,花亚伟,等.低位直肠肿瘤局部外科治疗[J].肿瘤2003,23(3)：248—249.
[14]许炳华,经肛门内镜下直肠肿瘤显微手术[J].国外医学外科学分册 2003,30(6)：326-329
[15]Demartines N, et al.Transanal endoscopic microsurgical excision of rectal tumors:Indications and results[J].World J Surg2001;25(7):870-875.
[16]Winde G, et al. Surgical cure for early rectal carcinomas (Tl). Transanal endoscopic microsurgery vs. anterior resection[J]. Dis Colon Rectum1996,39(9):969-976
[17]Visser BC, et al. Local therapy for rectal cancer[J]. Surg Oncol.2001,10(1-2):61-69.
[18]蒙家兴,林国乐,刘应裕,等.经肛门内镜显微手术治疗直肠绒毛状腺瘤和早期直肠癌31例[J].中国微创外科杂志,2006,1(6)：15-18.
[19]但汉雷,张亚历.小肠功能障碍与衰竭的诊断和评分[J].世界华人消化杂志,2002,10(10)：1197—1200
[20]Guerrieri M, et al. Treatment of rectal adenomas by transanal endoscopic microsurgery:15years'experience[J].Surg Endosc.2010,24(12):445-449
[21]邱辉忠,林国乐,肖毅,吴斌.经肛门内镜微创手术治疗直肠肿瘤120例[J].协和医学杂志.2011,2(1)：33-36
[22]刘波,夏立健,于海华,陈景波,杨明宇,李凯等.经肛门内镜微创手术治疗直肠肿瘤的手术经验[J].中国微创外科杂志.2011,11(3)：240-242
[23]林国乐,邱辉忠,,蒙家兴,等.经肛门内镜显微手术在直肠肿瘤局部切除术中的应用[J].中国现代手术学杂志,2006,5(10)：334-337.
[24]Nadine DF,Theodore JS.Transanal endoscopic microsurgical resection of pTl rectal tumors[J].Dis Colon Rectum,2005,49(1):164-168.
[25]蒙家兴,邵初晓,刘应裕,等.经肛门内镜显微手术切除直肠肿瘤[J].中华胃肠外科杂志,2003,3(6)：96-98.
[26]李建国.结直肠腺瘤性息肉诊治新进展[J].国际病理科学与临床杂志,2011,31(2)：150-154
[27]Dehle P,Largiader F,Jenny S,et al.A method for endoscopic lectroresection of sessile colonic polyps.Endoscopy,1973,5:38-40.
[28]Lightdale CJ. Endoscopicmucosal resection:This is our turf [J]. Endoscopy2004,36(9):808-810.
[29]王伟,李兆申.内镜治疗胃肠道早期肿瘤的新理念、新技术[J].中华消化内镜杂 志,2009,9：986-991.
[30]Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract-Hook knife EMR method[J]. Min.Invas. Ther. Allied Technol2002;11:291-295.
[31]Oh YS, E arly DS, A zar RR. C lin ical appl icat ion s of endoscopic ultrasound to on cology [J]. On cology,2005,68(4-6):526-537.
[32]Peters FP, Kara MA, Rosmolen WD,et al. Endoscopic treatment of high-grade dysplasia and early stage cancer in Barrett's esophagus[J]. Gastrointest Endosc,2005,6(l):506-514.
[33]Kantsevoy SV,Adler DG,et al.Endoscopic mucosal resection and endoscopic submucosal dissection [J]. Gastrointest Endosc,2008,6(8):11-18
[34]Oda I,Gotoda T,Hamanaka H,et al.Endoscopic submucosal dissection for early gastric cancer:technical feasibility,operation time and complications from a large consecutive series[J]. Dig Endosc,2005,17:54-58
[35]姚礼庆,钟芸诗.内镜黏膜下剥离术在中低位直肠肿瘤中的应用[J]中国实用外科杂志.2009,29(4)
[36]孙爱武,张奕萌,鲁志诚,等.内镜下黏膜切除术在消化道肿瘤中的应用[J].中国内镜杂志,2005,11：1075-1077.
[37]Kakushima N and Fujishiro M. Endoscopic submucosal dissection for gastrointestinal neoplasms [J]. World J Gastroenterol,2008,14(19):2962-2967.
[38]Gotoda T,et al.Endoscopic submucosal dissection of early gastric cancer[J].J Gastroenterol,2006,41(10):929-942.
[39]Fujishiro M, et al. Successful nonsurgical management of perforation complicating endoscopic submucosal dissection of gastrointestinal epithelial neoplasms[J].Endoscopy,2006,38(10):1001-1006
[40]Lieberman D.Rectal bleeding and diminutive colon polyps[J]. Gastroenterology.2004:126:1167-1174
[41]Chiu YS,Spencer RJ.Villous lesions of the colon[J].Dis Colon Rectum,1978,21:493-495.
[42]Buess G,Mentges B,Manncke K,Starlinger M, Becker HD. Technique and results of transanal endoscopic microsurgery in early rectal cancer[J]. Am J Surg1992;163:63
[43]KS. Transanal endoscopic microsurgery. Initial registry results[J].Dis Colon Rectum1996;39:S79-84
[44]Adam IJ, Shorthouse AJ. Outcome following transanal endoscopic Microsurgery [J]. Dis Colon Rectum1998;41:526-527
[45]顾红,田雨,李美星,李会,王嶙。内镜下黏膜切除术在结直肠腺瘤治疗中的应用[J].现代中西医结合杂志.2011,20(9)：1051-1053
[46]Maslekar S, Beral DK, White T J, et al. Transanal endoscipic Microsurgery:where are we now?[J] Dig Surg,2006,23(1-2):12-22
[47]赵刚,肖刚,周新平,余涛,杨华,黄美雄.经肛门内镜微创手术治疗直肠肿瘤[J].腹腔镜外科杂志.2010.15(6)：421-424
[48]Paty PB, Nash GM, Baron P, et al. Long-term results of localexcision for rectal cancer[J]. Ann Surg,2002,236(4):522-529
[49]Sutton CD, Marshall LJ, White SA, et al. Ten-year experience of endoscopic transanal resection[J]. Ann Surg,2002,235(3):355-562
[50]夏立建,直肠肿瘤局部切除治疗进展[J].中国肿瘤临床.2006.33(22)：1312-1315
[51]Yoshida N, Yagi N, Naito Y, et al. Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing [J]. World J Gastroenterol,2010,16(14):1688-1695
[52]Kaltenbach T, Soetikno R.Endoscopic mucosal resection of nonpolypoid colorectal neoplasm [J]. Gastroin test Endosc Clin N Am,2010,20(3):503-514
[53]Saito Y, Matsuda T, Fujii T. Endoscopic submucosal dissection of nonpolypoid colorectal neoplasms[J]. Gastroin test Endosc C lin N Am,2010,20(3):515-524
[54]Baik SH, Kwon HY, Kim JS, et al. Robotic versus laparoscopic low anterior resection of rectal cancer:short-term outcome of a prospective comparative study [J]. Ann Surg Oncol,2009,16(6):1480-1487.
[55]Patel CB, Ramos-Valadez DI, Haas EM. Robotic-assisted laparoscopic abdominoperineal resection for anal cancer:feasibility and technical considerations [j]. Int J Med Robot,2010,6(4):399-404.