直肠腺瘤性息肉局部切除治疗的对比研究  

A comparative study on local resection of rectal adenomatous polypus

作　　者：赵天成[1] 张斌[1] 

机构地区：[1]吉林大学中日联谊医院内镜中心,长春130033

出　　处：《中华消化内镜杂志》2014年第4期198-201,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜微创治疗术、经肛门内镜下显微手术、经肛门局部切除术针对直肠腺瘤性息肉的治疗价值。方法回顾性收集2009年至2011年行内镜微创治疗术（包括内镜黏膜切除术、内镜黏膜下剥离术及内镜下常规息肉切除，内镜微创治疗组），经肛门内镜下显微手术（经肛门内镜下显微手术组）及经肛门局部切除术（经肛门局部切除组）的直肠腺瘤性息肉患者195例，每组65例，汇总入选患者的临床资料并行统计分析。研究指标包括患者性别和年龄、术前疾病状况（病变形态分型、距肛缘距离、直径以及病理组织学分型）、手术疗效（成功率、术中及术后并发症发生率）、手术时间、住院时间及治疗费用。结果内镜微创治疗组病变距肛缘（8．46±3．27）em，明显长于经肛门局部切除组的（6．83±2．99）em（P〈0．05）。手术成功率（P=0．774）、术后出血发生率（P=0．632）3组间差异均无统计学意义。内镜微创治疗组术中出血量较多（≥100m1）者为6．2％（4／65），明显少于经肛门局部切除组的21．5％（14／65）（P〈0．05）。内镜微创治疗组平均手术时间、平均住院时间和平均治疗费用均明显短于或少于其他2组（P〈0．01）。结论内镜微创治疗术是直肠腺瘤性息肉局部切除治疗的理想手术方式。Objective To compare the therapeutic effects of endoscopy, TEM, and transanal local resection in rectal adenomatous polyps. Methods Data of 195 patients with rectal adenomatous polypus, who underwent either endoscopic resection （ EMR, ESD and conventional endoscopic resection, n = 65）, TEM （ n = 65 ） or transanal local resection （ n = 65 ） in the past two years （2009 - 2011 ） were retrospective- ly collected and analyzed. Results Distance from lesion to anus in endoscopic group was significantly longer than that in transanal group （P 〈 0. 05 ）. Bleeding volume during the procedure in transanal group was sig- nificantly larger than that in endoscopic group （ P 〈 0.05 ）. The operation time and hospitalization time in endoscopic group were significantly shorter than- those in TEM group and transanal group （ P 〈 0.01 ）. The total cost in endoscopic group was significantly lower than that in other 2 groups （P 〈 0. 01 ）. Conclusion Endoscopic resection is a safe and effective therapy for rectal adenomatous polypus.

关 键 词：直肠肿瘤 腺瘤 局部切除 显微外科手术 

分 类 号：R735.37[医药卫生—肿瘤]