内镜黏膜下剥离术和经肛门内镜下微创手术治疗直肠肿瘤的比较

Comparison between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumor

目的比较内镜黏膜下剥离术（ESD）与经肛门内镜下微创手术（TEM）治疗对于直肠肿瘤的疗效以及安全性。方法选取进行ESD治疗的直肠腺瘤42例，直肠早期癌27例以及直肠神经内分泌肿瘤18例，以及TEM治疗的直肠腺瘤25例，直肠早期癌18例以及直肠神经内分泌肿瘤9例，观察两组肿瘤大小、位置、完整切除、治愈性切除、手术操作时长、并发症、抗生素使用、住院时间、术后复发率等指标。结果两组肿瘤大小[（7．8±3．4）cm比（6．9±3．5）cm，P=0．398]，位置[距离肛缘（7．8±3．4）cm比（6．9±3．5）cm，P=0．320]，完整切除（100％比100％）、治愈性切除（94．3％比100．0％，P=0．053）、穿孔率（6．9％比0％，P=0．053）和术后复发率（0％比0％）差异无统计学意义；ESD组手术操作时长[（42．1±27．3）min比（78．5±21．3）min，P=0．018]、抗生素使用（32．2％比100．0％，P=0．000）及住院时间[（6．3±4．8）d比（13．7±2．9）d，P=0．021]明显低于TEM组，而TEM组术中出血量[（53．0±18．7）ml比（31．7±12．4）ml，P=0．033]小于ESD组，差异有统计学意义。结论ESD是治疗直肠肿瘤的有效方法。

Objective To compare the efficacy and safety between endoscopic submucosal dissection （ESD） and transanal endoscopic mierosurgery （TEM） for the treatment of rectal tumors, including rectal adenoma, early rectal carcinoma, and rectal neuroendocrine tumors （NET）. Methods We conducted an analysis including 139 patients with rectal tumors who underwent ESD （87） or TEM （52）. The size of the tumor, location of the tumor, en bloc resection, R0 resection, procedure time, hospital stay, complications, etc, between the two groups were evaluated and analyzed. Results There was no significant difference in tumor size~ （ 7.8 ± 3.4） cm vs. （ 6.9 ± 3.5 ） em, P = 0. 398 ], location [ （ 7.8 ± 3.4 ） em vs. （6.9±3.5） cm,P=0.320], en bloc resection （100% vs. 100%）, R0 resection （94.3% vs. 100.0% ,P = 0. 053） , perforation rate （6. 9% vs. 0% ,P = 0. 053 ） and the recurrence of the same loca- tion （0% vs. 0%） between the two groups. Procedure time [（42.1 ± 27.3） min vs. （78.5 ± 21.3） min, P = 0. 018 ], the use of antibiotics （32. 2% vs. 100% ,P = 0. 000） and hospital stay [ （6. 3 ± 4. 8） days vs. （13.7 ± 2.9） days,P= 0.021 ] in the ESD group were significantly shorter than ESD group. The volume of intraoperative bleeding of the patients in the TEM group was less than that in ESD group [（53.0±8.7） mlvs. （31.7±2.4） ml,P=0.033].Conclusion ESD is a safe and effective therapy for rectal tumors.