不同术式治疗直肠癌的前瞻性随机对照研究  

Prospective randomized controlled study on different surgical procedures for treating rectal cancer

作　　者：舒新军 赫长胜 任学宝 SHU Xinjun;HE Changsheng;REN Xuebao(Department of Gastrointestinal Surgery,the Affiliated Hospital of Qingdao Binhai University,Qingdao 266404,China;Department of Hepatobiliary Surgery,Qingdao Jiaozhou Central Hospital,Qingdao 266300,China)

机构地区：[1]青岛滨海学院附属医院胃肠外科,山东青岛266404 [2]青岛市胶州中心医院肝胆外科,山东青岛266300

出　　处：《长春中医药大学学报》2024年第8期897-900,共4页Journal of Changchun University of Chinese Medicine

基　　金：国家卫生健康委“十四五”规划全国重点课题项目(YYWS4149)。

摘　　要：目的探讨内镜黏膜下剥离术(ESD)与经肛门内镜下微创手术(TEM)治疗直肠癌(RC)的疗效。方法选择88例直肠癌患者,随机数表法分为A组与B组,A组(43例)采用经肛门内镜下微创手术治疗,B组(45例)采用内镜黏膜下剥离术治疗,2组术后均随访6个月。结果术后6个月,B组治疗总有效率高于A组(P<0.05)。B组术中出血量高于A组,平均住院时间、手术时间均短于A组(P<0.05);B组抗生素使用率低于A组(P<0.05)。随访期间,2组肿瘤完整切除率、肿瘤残留率、复发率及并发症发生率比较,差异均无统计学意义(P>0.05)。与术前比较,术后7 d,2组血清血管内皮生长因子B(VEGFB)、胃动素、血管内皮生长因子A(VEGFA)、嗜铬粒蛋白A(CgA)和血管内皮生长因子C(VEGFC)水平均降低,B组低于A组;血清D-乳酸(DLA)水平均升高,B组高于A组(P<0.05)。结论内镜黏膜下剥离术和经肛门内镜下微创手术治疗直肠癌的临床疗效及安全性均较好,临床可根据患者具体情况选择术式。Objective To explore the therapeutic efficacy of endoscopic submucosal dissection(ESD)and transanal endoscopic microsurgery(TEM)in the treatment of rectal cancer(RC).Methods 88 patients with RC were selected and divided into group A(43 cases)and group B(45 cases)according to random number table method.Group A received TEM,while group B received ESD.Both groups were followed up for 6 months after surgery.Results At 6 months after surgery,the total effective rate of group B was higher than that of group A(P<0.05).The amount of intraopeative bleeding in group B was higher than that in group A,and the average length of hospital stay and surgery time were shorter than those in group A(P<0.05).The usage rate of antibiotics in group B was lower than that in group A(P<0.05).During the follow-up period,there were no statistically signifi cant diff rences in the complete tumor resection rate,tumor residual rate,recurrence rate,and incidence of complications between two groups(P>0.05).Compared with before surgery,at 7 days after surgery,levels of serum vascular endothelial growth factor B(VEGFB),motilin,vascular endothelial growth factor A(VEGFA),chromogranin A(CgA),and vascular endothelial growth factor C(VEGFC),decreased in both groups,and group B was lower than group A;The levels of serum D-(−)-Lactic acid(DLA)all increased,and group B was higher than group A(P<0.05).Conclusion ESD and TEM have good clinical effi cacy and safety in the treatment of RC,and appropriate surgical procedures can be selected based on the specific situation of patients in clinical practice.

关 键 词：直肠癌 内镜粘膜下剥离术 经肛门内镜下微创手术 

分 类 号：R735.37[医药卫生—肿瘤]