The Comparative Study Of The Clinical Efficacy Of Early Rectal Cancer After TEM Surgery Compared With Traditional Open Surgery And Laparoscopic Surgery

Objective:To compare the incidence of complications and recurrence rate of early rectal cancer treated with TEM with that of traditional open surgery and laparoscopic surgery.Methods:Collect the information of patients with early rectal cancer who received open or laparoscopic surgery in gastrointestinal surgery of Shanxian central hospital from January 2005 to January 2015,and the information of patients with early rectal cancer who received TEM in gastrointestinal surgery of Shandong Provincial Qianfoshan Hospital.The medical records of 116 patients were retrospectively analyzed,Among them,38 cases were in laparoscopic surgery group,35 cases in open surgery group and 43 cases in TEM group.Statistically analyzed the general data(age,gender),tumor characteristics(maximum diameter,distance from anal margin),operation time,postoperative bowel ventilation time,hospital stay time,incidence of 1 complications,tumor recurrence rate.Results:There was no significant difference between each groups in the general data(age,gender),tumor characteristics(maximum diameter,distance from the anal margin)(all p>0.05).A11 the patients treated with TEM had complete resection of the lesion.Total mesorectal resection was performed in patients undergoing laparoscopic surgery and traditional open surgery.The operating time in the TEM group,laparoscopic group and open group was 60.22 ±10.35minutes,160.06±47.30minutes,and150.00±41.80minutes,respectively;Postoperative bowel ventilation time was 30.50± 10.76h?60.46± 13.51h?90.52± 11.02h,respectively;the total hospital stay time was 7.53 ± 1.67d?9.40±2.70d?12.39 ± 3.85d,respectively.Significant differences were found between TEM and the other two groups in operation time,postoperative intestinal ventilation time and total hospital stay time(p<0.05).The TEM group was superior to the other two groups in all aspects above,and the laparoscopic group was superior to the open group in postoperative intestinal ventilation time and total hospitalization time,which was statistically significant between each two groups(p<0.05).The intraoperative blood loss in the TEM group,laparoscopic group and open group was4.12±1.23ml,95.40±25.10ml,and 100.52± 12.30ml,respectively;Significant differences was found in intraoperative blood loss between the TEM group and the other two groups(p<0.05),TEM group had obvious advantages.No complications of perforation occurred in three groups.1 patient in the TEM group suffered anal pain after surgery,which was relieved after 24-48h of observation,considered to be due to the large diameter of the proctoscope,Another one patient suffered urinary retention after operation,but ameliorated after indwelling catheter.In the laparoscopic group,urinary retention,wound infection,anastomotic leakage were found in one case,respectively,and sexual dysfunction in three cases.There were 4 cases of surgical incision infection in the open surgery group,1 case of anastomotic stenosis,1 sexual dysfunction,1 urinary retention,and 1 rectovaginal fistula.Two cases of postoperative complications were found in the TEM group,accounting for 4.65%.There were 6,in total,patients suffered postoperative complications in the laparoscopic group,accounting for 15.79%.Eight patients suffered postoperative complications after open surgery,accounting for 22.86%.The difference in postoperative complications was statistically significant between the TEM group and the other two groups(p<0.05).By the end of the follow-up period of 2 years after the operation,none of the patients in the three groups was lost or died.During the follow-up of the TEM group,local recurrence occurred in 2 patients(24 months after the operation),followed by laparoscopic radical surgery later,and recovered after the operation.In the laparoscopic surgery group,one patient experienced local recurrence at 22 months,while another patient experienced local recurrence at 23 months postoperatively.One patient had local recurrence 21 months after operation in open surgery group.The patients in the open surgery group and the laparoscopic sugery group were treated with permanent colostomy after remediation surgery,and the outcome was satisfactory after combined radiotherapy and chemotherapy,No statistical significance was found in postoperative recurrence rate among three groups(p>0.05).Conclusion:1.The laparoscopic surgery was superior to the open surgery in terms of postoperative bowel ventilation time and hospital stay time.2.Compared with laparoscopic surgery and open surgery,transanal endoscopic microsurgery(TEM)has the advantages of shorter hospital stay time,less surgical trauma,shorter operative time,less intraoperative blood loss,less postoperative complications and rapid postoperative intestinal function recovery..3.TEM can achieve the same therapeutic effect as laparoscopic surgery and open surgery in treating early rectal cancer.Meanwhile,it can reduce the incidence of urinary retention and sexual dysfunction after surgery and significantly improve the postoperative quality of life of patients.4.The efficacy of transanal endoscopic microsurgery(TEM)for early rectal cancer(T1N0M0)is safe and effective.With the recognition of its clinical advantages and acceptance by more experts,its clinical application will be promoted gradually and have a good prospect of development.