腹腔镜与经肛门内镜微创手术切除直肠神经内分泌肿瘤的短期疗效比较

Comparison of the short-term effects of laparoscopic resection and TEM resection for rectal neuroendocrine tumors

目的比较腹腔镜手术与经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)切除直肠神经内分泌肿瘤的短期疗效。方法回顾性分析2011年8月至2015年6月本院收治的24例肿瘤最大径小于2cm的直肠神经内分泌肿瘤患者的临床资料,其中腹腔镜切除组13例,TEM切除组11例。比较两组患者切除标本的大小、切缘阳性率、术中失血量、中转开腹率、手术时间、首次排气时间、术后住院天数、术后并发症(穿孔、出血、感染、肛门功能、肠瘘等)、术后疼痛及围术期死亡情况等。结果两组患者的切缘阳性率、中转开腹率、术后并发症及围术期死亡情况比较差异无显著性(P>0.05)。TEM切除组患者切除的标本小于腹腔镜切除组[(3.45±0.48)cm vs (10.19±1.01)cm,P<0.05],手术时间短于腹腔镜切除组[(62.27±8.17)分钟vs (147.69±20.58)分钟,P<0.05],术后住院时间短于腹腔镜切除组[(4.00±0.89)天vs(9.84±1.46)天,P<0.05],术后首次排气时间早于腹腔镜切除组[(40.90±6.53)小时vs(63.38±9.61)小时,P<0.05],术中出血量少于腹腔镜切除组[(16.36±6.74)ml vs (51.54±23.39)ml,P<0.05]。TEM组术后12、24、48小时的疼痛视觉模拟评分均明显低于腹腔镜切除组(P<0.05)。结论对于肿瘤最大径小于2cm的直肠神经内分泌肿瘤,TEM切除与腹腔镜切除后患者的生存期及术后并发症无明显差异,且TEM切除具有手术时间短、创伤小、术后恢复快等优点,值得进一步推广应用。

Objective To compare the short term efficacy of laparoscopic resection and TEM resection for rectal neuroendocrine tumors. Method Retrospective analysis was performed on the clinical data of 24 patients with rectal neuroendocrine tumors sized below 2 cm admitted to Shengjing Hospital of China Medical University from August 2011 to June 2015, including 13 who underwent laparoscopic resection and 11 who underwent TEM resection. The two groups were compared for the short-term clinical efficacy in terms of, e.g., size of resected specimens, positive surgical margin rate, intraoperative blood loss, laparotomy conversion rate, surgery duration, time to first flatus, postoperative days of hospital stay, postoperative complications（perforation, hemorrhage, infection, anal dysfunction, intestinal fistula, etc.）, postoperative pain, and perioperative deaths. Result For patients with rectal neuroendocrine tumors sized below 2 cm There were no statistically significant differences between the two groups in positive surgical margin rate, laparotomy conversion rate, postoperative complications or perioperative deaths（P〉0.05）. The specimen size was smaller in TEM resection group than in laparoscopic resection group [（3.45±0.48）cm vs（10.19±1.01）cm, P〈0.05]; the surgery duration was shorter in TEM group than in laparoscopic resection [（62.27±8.17）min vs（147.69±20.58）min, P〈0.05]; the length of postoperative hospital stay was shorter in TEM resection group than in laparoscopic resection [（4.00±0.89）d vs（9.84±1.46）d, P〈0.05]; the time to first flatus was shorter in TEM resection group than in laparoscopic resection [（40.90±6.53）h vs（63.38±9.61）h, P〈0.05）; the intraoperative blood loss was less in TEM resection group than in laparoscopic resection group [（16.36±6.74）ml vs（51.54±23.39）ml, P〈0.05）; and the pain scores at 12 h, 24 h and 48 h postoperatively were lower in TEM resection group than in laparoscopic resection group（P〈0.05）. Conclusion For patients with rectal neuroendocrine tumors sized below 2 cm, TEM resection and laparoscopic resection did not present significant differences in postoperative complications, and TEM resection was advantageous in short surgery duration, minimal invasion, quick postoperative recovery, etc., supporting its further application.