早期直肠肿瘤经肛门与内镜下切除治疗的效果比较  

Comparison of efficacy and safety between transanal and endoscopic resection for early rectal tumors

作　　者：王东[1] 杨关根[1] 裘建明[1] 邵书先[1] 汪长建 WANG Dong;YANG Guangen;QIU Jianming;SHAO Shuxian;WANG Changjian(Department of Proctology,Hangzhou Third People's Hospital,Hangzhou 310009,China)

机构地区：[1]杭州市第三人民医院肛肠科,310009

出　　处：《浙江医学》2022年第10期1083-1086,共4页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF20H270001)。

摘　　要：目的比较早期直肠肿瘤经肛门与内镜下切除治疗的效果。方法选取2017年6月至2020年6月在杭州市第三人民医院行手术治疗的早期直肠肿瘤患者80例,其中采取经肛门手术44例,内镜下手术36例;比较两种术式患者围术期情况以及手术前后大便失禁评分指数(FISI)、36条简明健康状况调查表(SF-36)评分、肛管直肠测压指标[包括肛管直肠静息压力(ARP)、直肠容积感觉阈值(RVST)、直肠最大耐受容积(MTV)、肛门最大收缩压(MSP)]等。结果在手术时间、术中出血量、术后出血发生率、术中穿孔发生率等方面,经肛门手术明显优于内镜下手术(均P<0.05);在住院费用、术后疼痛发生率等方面,内镜下手术明显优于经肛门手术(均P<0.05)。术前两种术式患者FISI及SF-36评分、各项肛管直肠测压指标比较,差异均无统计学意义(均P>0.05);术后1个月内镜下手术患者ARP高于经肛门手术患者(P<0.05),RVST及MTV均低于经肛门手术患者(均P<0.05);术后6个月内镜下手术患者FISI评分明显低于经肛门手术患者(P<0.05),两种术式患者SF-36生理及心理评分、各项肛管直肠测压指标比较,差异均无统计学意义(均P>0.05)。结论早期直肠肿瘤经肛门与内镜下切除治疗各有利弊,内镜下手术对术者的技术要求较高,术中易发生穿孔、出血等并发症;经肛门手术相关并发症较少,但对于直肠上段肿瘤的操作难度较大。Objective To compare the efficacy and safety of transanal and endoscopic resection for early rectal tumors.Methods A total of 80 patients with early-stage rectal tumors who underwent resection in Hangzhou Third People's Hospital from June 2017 to June 2020 were enrolled,including 44 patients receiving transanal surgery(transanal group)and 36 patients receiving endoscopic surgery(endoscopic group).The perioperative conditions,fecal incontinence score index(FISI),36-item brief health status questionnaire(SF-36)score,anorectal manometry index before and after surgery(including ARP),rectal volume sensory threshold(RVST),rectal maximum tolerated volume(MTV)and anal maximum systolic blood pressure(MSP)were measured and compared between two groups.Results The operation time,intraoperative blood loss,incidence of postoperative bleeding,and incidence of intraoperative perforation,transanal surgery in transanal group was significantly better than those in endoscopic group(all P<0.05).On the other hand,the hospitalization costs and incidence of postoperative pain in endoscopic group was significantly lower than those in transanal group(all P<0.05).There were no significant differences in the FISI and SF-36 scores and various anorectal manometry indexes between the two groups before surgery(all P>0.05).One month after the operation,the ARP of patients undergoing endoscopic surgery was higher than that of patients undergoing transanal surgery(P<0.05),and the RVST and MTV were lower than those of patients undergoing transanal surgery(all P<0.05).The FISI score of patients undergoing endoscopic surgery at 6 months after surgery was significantly lower than that of patients undergoing transanal surgery(P<0.05).There were no significant differences in SF-36 physical and psycholog ical scores and various anorectal manometry indexes between the two groups(all P>0.05).Conclusion Transanal and endoscopic resection of early-stage rectal tumors have pros and cons.Endoscopic surgery requires high operating skill for the surgeon,and comp

关 键 词：直肠肿瘤 经肛门手术 内镜下手术 肛门功能 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]