经肛门内镜微创手术治疗70岁以上早期直肠癌患者的疗效观察

Transanal endoscopic microsurgery for early rectal cancer in patients over 70 years old

目的评价经肛门内镜微创手术(TEM)治疗70岁以上早期直肠癌患者的临床疗效。方法回顾性分析北京市肛肠医院结直肠外科(二)病区收治的41例经TEM治疗的70岁以上早期直肠癌患者的临床资料。结果41例患者手术时间20~45 min,平均(32.0±5.1)min;术中出血量2~4 mL,平均(2.5±0.7)mL;住院时间5~9 d,平均(6.7±1.0)d。41例患者均无发热、泌尿系统感染、伤口感染、大便失禁、直肠狭窄、直肠穿孔、直肠阴道瘘等并发症发生,1例患者发生尿潴留,1例患者发生肛门疼痛,2例患者发生术后出血。术前超声分期:uT0期12例,uT1期29例。术后病理诊断:管状腺瘤伴高级别上皮内瘤变(黏膜内癌)12例,管状绒毛状腺瘤伴高级别上皮内瘤变(黏膜内癌)28例,管状绒毛状腺瘤恶变(腺癌Ⅱ级,侵及浅肌层)1例。术后病理分期:pT0期12例,pT1期28例,pT2期1例,侵及浅肌层者其术前超声分期为uT1期。术后随访时间12~24个月,平均(17.4±3.1)个月,无死亡病例,复查电子结肠镜、直肠腔内超声、腹盆腔CT等检查,均未发现原位复发。结论TEM治疗70岁以上早期直肠癌患者安全、有效、微创、并发症少。

Objectives To investigate the efficacy of transanal endoscopic microsurgery(TEM)for early rectal cancer in patients over 70 years old.Methods This was a retrospective analysis of 41 patients with early rectal cancer treated with TEM at divisionⅡof Colorectal Surgery,Beijing Anorectal Hospital.Results Surgery duration ranged from 20 to 45 min with the mean(SD)duration of 32.0(5.1)min.Intraoperative blood loss ranged from 2 to 4 mL with the mean(SD)blood loss of 2.5(0.7)mL.Duration of hospitalization ranged from 5 to 9 days with the mean(SD)duration of 6.7(1.0)days.No patients experienced fever,urinary system infection,wound infection,incontinence,rectal stricture,rectal perforation,and rectovaginal fistula.One patient had urinary retention,one had anal pain,and two had postoperative bleeding.Preoperative ultrasound staging showed 12 uT0 and 29 uT0.Postoperative pathology showed 12 cases of tubular adenoma with high-grade intraepithelial neoplasia(intramucosal carcinoma),28 cases of tubular villous adenoma with high-grade intraepithelial neoplasia(intramucosal carcinoma),and 1 case of malignant degeneration of tubular villous adenoma(adenocarcinoma,stageⅡ,invasion of muscularis propria).Postoperative pathology showed 12 cases of stage pT0,28 pT1,and one pT2 with the invasion of muscularis propria and preoperative ultrasound stage uT1.Postoperative follow-up ranged from 12 to 24 months(with the mean(SD)follow-up was 17.4(3.1)months).There was no death and no recurrence during follow-up.Conclusion TEM is a safe,effective,and minimally treatment for early rectal cancer in patients older than 70 years old.It has few complications.