| Objective: In order to provide valuable clues and references for selecting treatment in a more scientific and reasonable manner on clinical rectal tumor therapy, this research explored a superior surgical approach between transanal endoscopic microsurgery(TEM) and traditional transanal local resection. The two approaches are evaluated comparatively from several aspects, surgical treatment effects, postoperative recovery conditions etc.Method:109 clinical cases, that objects were under treatment at Gastrointestinal Tumor Surgery of Fujian Provincial Cancer Hospital in the past three years(2012.07—2016.01), were retrospectively collected and analyzed for this comparative research, which include rectal adenomas, early rectal cancer and rectal neuroendocrine tumor. Among the 109 cases, 33 objects underwent TEM(TEM group n=33), and 76 objects used traditional transanal local resection(traditional transanal local resection group n=76) as treatment. The attributes taken into account in this research include gender, age, lesion diameter, pathological type, success rate of operation, blood loss, operation time, patients' postoperative complications, distance from lesion to anus, rate of negative microscopic margins, rate of complete tumor specimen, exhaust time, recovery of oral intake,and postoperative hospital stay of two groups were compared with each other.Results:No statistically significant difference was found between the two groups in terms of patients' age,gender,lesion diameter and pathological type. In comparison with transanal local resection group,TEM group has less blood loss(15ml vs 45 ml,p<0.001),shorter operation time(45min vs 60 min,p=0.032),less patients' postoperative complications(1vs 23,p=0.002),less postoperative bleeding( 1 vs 15,p=0.049), less postoperative pyrexia(0 vs 12,p=0.037), longer distance from lesion to anal(7.8±3.6cm vs 3.9±1.3cm, p < 0.001), higher rate of complete tumor specimen( 100% vs 75%,p=0.002),shorter exhaust time(0.5 day vs 2 days,p<0.001), quicker recovery of oral intake(1day vs 3days,p<0.001),and shorter postoperative hospital stay(3 days vs 6 days,p<0.001). The success rate of operation and the rate of negative microscopic margins of twogroups were both 100%. However, the difference between the two groups in terms of the presence of transient urinary retention(0 vs 2)showed no statistical significance(p=0.484).Conclusion:Several prominent advantages of employing TEM technique over transanal local resection include less blood loss, shorter operation time,less patients' postoperative complications, higher rate of complete specimen,shorter duration of postoperative recovery of gastrointestinal function and shorter postoperative hospital stay. TEM compensates for the limitation of traditional transanal local resection, which is only capable of curing the lower rectum tumor under direct vision, by managing tumors within 4-20cm's range from anus. In conclusion, TEM is a new measure for transanal local resection with safe and minimally invasive operation that is particularly useful in treatments for rectal or lower colorectal adenoma, early cancer and neuroendocrine tumor. TEM is a more widely applicable, more flexible operation measure with less harm and clearer operation vision in relative to traditional transanal local resection. The way TEM operates improves the ability and efficiency of curing tumor through transanal way, as well as speed of recovery and hospital turnover. Hence, TEM is worthwhile for further clinical development and applications. |
PDF Full Text Request