gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2025-24-1-46-52gnck-1977Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESТрансанальная эндомикрохирургия в лечении крупных и гигантских аденом прямой кишки. Непосредственные результаты проспективного исследованияTransanal endomicrosurgery in the treatment of large and giant rectal adenomas. Results of a prospective studyhttps://orcid.org/0000-0002-6212-9454ЧернышовС. В.ChernyshovS. V.

ул. Саляма Адиля, д. 2, г. Москва,123423

Stanislav V. Chernyshov 

Salyama Adilya st., 2, Moscow, 123423 

https://orcid.org/0000-0001-8189-3071МайновскаяО. А.MainovskayaO. A.

ул. Саляма Адиля, д. 2, г. Москва,123423

Olga A. Mainovskaya 

Salyama Adilya st., 2, Moscow, 123423 

https://orcid.org/0000-0002-0735-2100НагудовМ. А.NagudovM. A.

ул. Саляма Адиля, д. 2, г. Москва,123423

Marat A. Nagudov 

Salyama Adilya st., 2, Moscow, 123423 

polikarpova-e@yandex.ruhttps://orcid.org/0000-0001-5848-4050ЛикутовА. А.LikutovA. A.

ул. Саляма Адиля, д. 2, г. Москва,123423

Aleksey A. Likutov 

Salyama Adilya st., 2, Moscow, 123423 

https://orcid.org/0009-0003-2074-4170ТишкевичИ. С.TishkevichI. S.

ул. Саляма Адиля, д. 2, г. Москва,123423

Ilya S. Tishkevich  

Salyama Adilya st., 2, Moscow, 123423 

https://orcid.org/0000-0002-3919-9067РыбаковЕ. Г.RybakovE. G.

ул. Саляма Адиля, д. 2, г. Москва,123423

Evgeny G. Rybakov 

Salyama Adilya st., 2, Moscow, 123423 

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhikh National Medical Research Center of ColoproctologyRussian Federation2025210320252414652Copyright © Чернышов С.В., Майновская О.А., Нагудов М.А., Ликутов А.А., Тишкевич И.С., Рыбаков Е.Г., 20252025Чернышов С.В., Майновская О.А., Нагудов М.А., Ликутов А.А., Тишкевич И.С., Рыбаков Е.Г.Chernyshov S.V., Mainovskaya O.A., Nagudov M.A., Likutov A.A., Tishkevich I.S., Rybakov E.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1977

ЦЕЛЬ: продемонстрировать возможности применения ТЭМ в условиях национального центра при лечении крупных (более 5,0 см) и гигантских (более 8,0 см) аденом прямой кишки.ПАЦИЕНТЫ И МЕТОДЫ: с 2011 по 2023 гг. выполнено более 1000 оперативных вмешательств в объеме трансанальной эндомикрохирургии. Согласно размеру опухоли были выделены три группы: I группа — опухоли размерами менее 5,0 см; II группа — опухоли размерами 5,0–8,0 см (крупные); III группа — опухоли размерами более 8,0 см (гигантские).РЕЗУЛЬТАТЫ: в итоговый анализ вошло 600 пациентов. В I группу с размерами менее 5,0 см включено 465/600 (77,5%) пациентов. II группу — крупных аденом 5,0–8,0 см составили 120/600 (20%) пациентов. В группу гигантских опухолей, размерами более 8,0 см, вошло 15/600 (2,5%) пациентов. В I группе (менее 5,0 см) частота R0-резекций достигала 92%, во II группе крупных аденом (5,0–8,0 см) она составляла всего 75%, а при удалении гигантских аденом (более 8 см) — 46% (р < 0,001). При проведении мультивариантного анализа, независимыми факторами риска выполнения R1-резекции были гигантский размер опухоли более 8,0 см (ОШ 5,5; 95% ДИ: 1,4–20,3; р = 0,006) и расположение новообразования в непосредственной близости от зубчатой линии (ОШ 2,6; ДИ: 1,17–5,89; р = 0,0005).ЗАКЛЮЧЕНИЕ: гигантский размер (более 8,0 см) и локализация аденомы в нижнеампулярном отделе прямой кишки в непосредственной близости от зубчатой линии являются независимыми факторами риска нерадикального удаления при трансанальной эндомикрохирургии.

AIM: the aim of this article was to demonstrate the possibilities of using TEM for large (more than 5.0 cm) and giant (more than 8.0 cm) rectal adenomas.PATIENTS AND METHODS: more than 1000 transanal endoscopic microsurgery procedures were performed in 2011- 2023. Three groups were distinguished according to the tumor size: Group I — tumors less than 5.0 cm; Group II — tumors 5.0–8.0 cm (large); Group III — tumors more than 8.0 cm (giant).RESULTS: the final analysis included 600 patients. Group I with sizes less than 5.0 cm included 465 (77.5%) patients. Group II — large adenomas 5.0–8.0 cm included 120 (20%) patients. The group of giant tumors, larger than 8.0 cm, included 15 (2.5%) patients. In group I (less than 5.0 cm), the R0 rate was 92%, then in group II of large adenomas (5.0–8.0 cm) it was only 75%, and in the case of removal of giant adenomas (more than 8.0 cm) — 46% (p < 0.001). In multivariate analysis, independent risk factors for R1 resection were giant tumor size over 8.0 cm (OR 5.5; 95% CI: 1.4–20.3; p = 0.006) and tumor site close to the dentate line (OR 2.6; CI: 1.17–5.89; p = 0.0005).CONCLUSION: giant size (over 8.0 cm) and adenoma site in the low rectum close to the dentate line are independent risk factors for non-radical resection during transanal endomicrosurgery.

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The authors declare that there are no conflicts of interest present.