经肛门内镜微创手术与传统经肛门局切术治疗早期直肠肿瘤的疗效对比

Local resection for early rectal tumours： comparative study of transanal endoscopic microsurgery versus conventional transanal excision

目的对比经肛门内镜微创手术（TEM）与传统经肛门局切术（TAE）治疗早期直肠肿瘤的应用指征、安全性、疗效。方法回顾性分析上海交通大学医学院附属瑞金医院普外科2003年1月-2006年7月完成的76例传统经肛门局切术及2006年9月-2010年2月完成的53例经肛门内镜微创手术的临床资料。结果两组患者性别、年龄、肿瘤大小、出血量、术后住院时间差异无统计学意义（P〉0．05），但TEM组肿瘤与肛缘距离高于TAE组（TEM／TAE=7．0／5．0cm，P〈0．01），TEM组手术时间也明显长于TAE组（TEM／TAE=70．00／30．00rain，P〈0．01）。TEM组4例、TAE组2例有术后并发症，两组差异无统计学意义（P〉0，05）。平均随访25—30个月后，TEM组总体复发率为7．8％，明显优于TAE组的23．2％（P〈0．05）。结论TEM是一种安全的经肛门途径的局部切除方法，与传统经肛门切除术相比，适用范围更广，疗效更佳，但掌握该技术具有一定难度。

Objective To compare the application, safety and theraputic effect of local resection of early rectal tumours by transanal endoscopic microsurgery（TEM） and the conventional transanal excision（TAE）. Methods The data of seventy-six patients who were treated by conventional transanal excision from January 2003 to July 2006 and fifty-three patients who were treated by transanal endoscopic microsurgery from September 2006 to February 2010 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were reviewed. Results Age, sex,turnout size, blood loss, postoperative hospital stay were similar in the two groups（P 〉0.05）. The median distance from the anal verge was significantly higher in the TEM group （TEM/TAE = 7.0/5.0 cm, P 〈 0.01 ）. The operation time was significantly longer in the TEM group （TEM/TAE =70.00/30.00 min, P 〈 0.01 ）. There was no operation-related mortality in both groups （P 〉 0.05）. Two patients in the TEM group developed postoperative haemorrhage, and one patient developed pulmonary infection and retention of urine respectively. There were two secondary haemorrhage cases in the TAE group. On median follow-up of 30 months, there was 7.8% recurrence rate in the TEM group,compared with 23.2% the in TAE group. Conclusions Transanal endoscopic microsurgery is a safe and effective mininally invasive surgical technique for the treatment of early rectal neoplasm. It has broader indication, and better theraputic effect than the conventional transanal excision.