经肛门内镜微创手术治疗直肠肿瘤临床分析

Clinical analysis of transanal endoscopic microsurgery in treatment of rectal tumors

目的探讨肛门内窥镜下的微创外科技术治疗直肠肿瘤的疗效。方法回顾性分析2011年9月~2015年9月入院治疗直肠肿瘤的140例患者,根据手术方案分为两组,观察组（n=70）患者实施经肛门内镜微创手术治疗,对照组（n=70）患者实施腹腔镜下行直肠癌根治术,对比两组术后肿瘤全切情况、手术时间、术中出血量、尿管留置时间、住院时间,随访患者术后并发症情况。结果两组患者肿瘤根治效果相同,差异无统计学意义（P〉0.05）,观察组患者手术时间、术中出血量、尿管留置时间、住院时间较对照组患者显著减少（P〈0.05）,观察组术后出现并发症患者共12例（17.1%）,对照组并发症患者17例（24.3%）,两组差异有统计学意义（P〈0.05）,两组患者均未见严重并发症发生。结论 TEM可使术野显露良好,切除范围准确,术后恢复快、复发率低,住院时间短,是一种可用于治疗直肠良性肿瘤的安全有效方案,尤其对位于直肠中上段的腺瘤及无转移直肠神经内分泌肿瘤效果突出。

Objective To investigate the effect after transanal endoscopic microsurgery in treatment of rectal tumors. Methods 140 patients with rectal tumors in our hospital from September 2011 to September 2013 were collected and retrospectively analyzed. According to surgery program, 140 patients were divided into two groups, the observation group（n=70） patients with treated by transanal endoscopic microsurgery,control group（n=70） patients were treated by laparoscopic radical resection,the complete resection of tumor/ operation time, bleeding volume,indwelling catheter time,hospital days after operation between two groups were compared.Postoperative complications of the patients were followed up. Results there was no significant different of the complete resection of tumor between two groups（P〉 0.05）;the operation time,bleeding volume,indwelling catheter time,hospital days of observation group were shorter than that in control gruop（P〈 0.05）;There were 12 cases with complications（17.1%） in the observation group and 17 cases（24.3%） in the control group,there was a significant difference between two groups（P〈 0.05）.No serious complications were founded in the two groups. Conclusion Transanal endoscopic microsurgery is a safety and effective minimally invasive surgical technique which can make better visualized operative field, more precise border excision, rapid recovery, a lower recurrence rate and short hospitalizing time. This minimally invasive technique is appropriate for benign lesions such as rectal adenomas and no transfer rectum neuroendocrine tumors.