经肛门微创外科手术治疗良性直肠肿瘤的效果及并发症观察

Efficacy and Complications of Transanal Endoscopic Microsurgery for Benign Rectal Tumors

目的比较传统经肛门局部切除术与经肛门微创外科手术(transanal endoscopic microsurgery,TEM)在治疗良性直肠肿瘤的近期并发症及疗效。方法回顾性分析2012年7月—2018年1月在福建省肿瘤医院行TEM和传统经肛门局部切除术的直肠良性肿瘤共112例患者资料,其中传统经肛门局部切除术76例(对照组),TEM组36例(观察组),将两组患者的一般情况、手术相关指标以及术后恢复指标进行统计分析。结果在术后恢复指标和手术治疗相关指标方面,观察组术中出血量[(11.39±5.55)mL vs.(56.05±21.96)mL]、手术时间[(58.05±16.40)min vs.(86.80±18.05)min]、术后首次排气时间[(1.33±0.57)d vs.(2.21±0.68)d]、术后首次进食时间[(1.33±0.48)d vs.(3.06±0.77)d]、术后住院天数[(2.53±0.70)d vs.(6.11±0.89)d]均显著优于对照组组,且观察组肿瘤距肛门距离及肿瘤直径大于对照组,差异有统计学意义(P<0.05)。结论与传统经肛门局部切除术对比,经肛门微创外科手术具有手术时间短、出血量少、胃肠道功能恢复快、术后住院时间短等多项显著优势,而且具有灵活的操作性、清晰的视野,创伤更小、适应证更广,可提高直肠良性肿瘤经肛门切除效率,使得患者手术后恢复更快,减少住院时间,加快住院周转率,适合在临床上进行推广应用。

Objective To observe and compare the short-term complications and efficacy of traditional transanal local resection and transanal endoscopic microsurgery(TEM)in the treatment of benign rectal tumors.Methods A total of 112 patients with benign rectal tumors who underwent TEM or traditional transanal local resection in Fujian Cancer Hospital from July 2012 to January 2018were retrospectively analyzed.Among them,76 patients underwent traditional transanal local resection(control group)and 36 patients underwent TEM(observation group).The general condition,operation related indicators and postoperative recovery indicators of the two groups of patients were statistically analyzed.Results In terms of postoperative recovery indicators and surgical treatment related indicators,in the observation group,the intraoperative bleeding was[(11.39±5.55)mL vs.(56.05±21.96)mL],the operation time was[(58.05±16.40)min vs.(86.80±18.05)min],the first exhaust time after operation was[(1.33±0.57)d vs.(2.21±0.68)d],and the first postoperative feeding time[(1.33±0.48)d vs.(3.06±0.77)d],and postoperative hospital stay[(2.53±0.70)d vs.(6.11±0.89)d]in the observation group were significantly better than those in the control group,and the distance from tumor to anus and tumor diameter in the observation group were larger than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with traditional transanal local resection,transanal endoscopic microsurgery has many significant advantages,such as shorter operation time,less intraoperative bleeding,faster recovery of gastrointestinal function,and shorter postoperative hospital stay.Moreover,it has flexible operation,clear vision,less trauma,and wider indications.It improves the efficiency of transanal resection of benign rectal tumors,and make patients recover faster after surgery,reduce the length of hospital stay,and speed up the hospitalization turnover rate,which is suitable for clinical application.