手套法经肛微创手术与经肛内镜微创手术治疗直肠肿瘤的临床疗效  

Clinical efficacy of transanal minimally invasive surgery with glove method and transanal endoscopic microsurgery in the treatment of rectal neoplasms

作　　者：周俊峰[1] 何庆良[1] 王家兴[1] 林晟 Zhou Junfeng;He Qingliang;Wang Jiaxing;Lin Sheng(The First Department of Gastrointestinal Surgery,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350004,China)

机构地区：[1]福建医科大学附属第一医院胃肠外科一区,福州350004

出　　处：《中华消化外科杂志》2020年第3期302-307,共6页Chinese Journal of Digestive Surgery

基　　金：福建省卫生计生青年科研课题(2018-1-52)。

摘　　要：目的探讨手套法经肛微创手术(TAMIS)与经肛内镜微创手术(TEM)治疗直肠肿瘤的临床疗效。方法采用回顾性队列研究方法。收集2015年3月至2017年5月福建医科大学附属第一医院收治的60例直肠肿瘤患者的临床病理资料;男34例,女26例;平均年龄为62岁,年龄范围为49~74岁。60例患者均行经肛手术,其中30例采用手套法TAMIS,设为TAMIS组;30例采用TEM,设为TEM组。观察指标:(1)手术及术后恢复情况。(2)术后短期并发症情况。(3)随访情况。采用门诊或电话方式进行随访,了解患者术后肿瘤复发转移情况。随访时间截至2018年8月。正态分布的计量资料以±s表示,组间比较采用t检验。计数资料以绝对数或百分比表示,组间比较采用χ^2检验或Fisher确切概率法。等级资料组间比较采用Mann-WhitneyU检验。结果(1)手术及术后恢复情况:两组患者均顺利完成手术。TAMIS组患者手术操作时间,术中出血量,术后首次肛门排气时间,术后首次进食半流质食物时间,术后肛门疼痛评分,术后住院时间,术后3个月肛门功能Kirwan分级(Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级)例数分别为(35±7)min,(9±5)mL,(2.7±0.9)d,(2.9±0.6)d,(2.1±0.9)分,(3.6±1.9)d,29、1、0、0、0例;TEM组患者上述指标分别为(38±7)min,(9±6)mL,(2.5±0.8)d,(2.7±0.7)d,(1.8±0.9)分,(4.0±2.3)d,28、1、1、0、0例,两组患者上述指标比较,差异均无统计学意义(t=-1.377,-0.099,0.931,0.770,1.418,-0.789,Z=-0.607,P>0.05)。TAMIS组和TEM组患者总手术时间分别为(38±7)min和(46±7)min,治疗费用分别为(8507±1471)元和(9551±1747)元,两组患者上述指标比较,差异均有统计学意义(t=-4.628,-2.506,P<0.05)。两组患者术后病理学检查结果示切缘均为阴性。(2)术后短期并发症情况:TAMIS组2例患者发生术后短期并发症,其中1例术前因合并前列腺增生症,术后发生尿潴留,经导尿膀胱训练3 d后改善,1例术后2 d畏冷、发热诊断为脓毒血�Objective To investigate the clinical efficacy of transanal minimally invasive surgery(TAMIS)with glove method and transanal endoscopic microsurgery(TEM)in the treatment of rectal neoplasms.Methods The retrospective cohort study was conducted.The clinicopathological data of 60 patients with rectal neoplasms who were admitted to the First Affiliated Hospital of Fujian Medical University from March 2015 to May 2017 were collected.There were 34 males and 26 females,aged from 49 to 74 years,with an average age of 62 years.Of the 60 patients,30 undergoing TAMIS with glove method and 30 undergoing TEM were allocated into TAMIS group and TEM group,respectively.Observation indicators:(1)surgical situations and postoperative recovery;(2)postoperative short-term complications;(3)follow-up.Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to August 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were represented as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparison of ordinal data between groups was analyzed by the Mann-Whitney U test.Results (1)Surgical situations and postoperative recovery:patients in the two groups underwent surgery successfully.The operation time,volume of intraoperative blood loss,time to postoperative first flatus,time to postoperative semi-fluid diet intake,postoperative anal pain score,duration of postoperative hospital stay and cases with Kirwan classificationⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅴof anus function at 3 months after surgery were respectively(35±7)minutes,(9±5)mL,(2.7±0.9)days,(2.9±0.6)days,2.1±0.9,(3.6±1.9)days,29,1,0,0,0 in the TAMIS groups and(38±7)minutes,(9±6)mL,(2.5±0.8)days,(2.7±0.7)days,1.8±0.9,(4.0±2.3)days,28,1,1,0,0 in the TEM group,showing no significant difference in the above indicators between the two groups(t=-1.377,-0.0

关 键 词：直肠肿瘤 经肛微创手术 经肛内镜微创手术 临床疗效 手术并发症 

分 类 号：R735[医药卫生—肿瘤]