直肠肿瘤患者经肛门微创外科手术治疗对并发症及胃肠功能恢复的影响

段新星 余雄

【摘要】 目的：探討直肠肿瘤患者经肛门微创外科手术治疗对并发症及胃肠功能恢复的影响。方法：选取2019年2月-2020年2月本院收治的直肠肿瘤患者98例，依据不同手术治疗方式分为对照组与研究组，每组49例。对照组行经肛门切除术治疗，研究组行经肛门内镜显微手术（transanal endoscopic microsurgery，TEM）治疗。比较两组术中出血量、手术时间、术后并发症、首次排气时间、首次进食时间及标本切缘阴性率。结果：研究组术中出血量与手术时间均低于对照组（P<0.05）。研究组术后并发症发生率低于对照组（P<0.05）。研究组术后首次排气时间及首次进食时间均短于对照组（P<0.05）。两组全部肿瘤病灶标本的切缘都未发现残留肿瘤细胞，即两组的标本切缘阴性率均为100%，比较差异无统计学意义（P>0.05）。结论：直肠肿瘤患者行TEM术可有效降低并发症，促使患者术后更快恢复胃肠功能，且在标本切缘阴性率方面与传统手术方式相当。

【关键词】 直肠肿瘤 TEM 并发症 胃肠功能 切缘阴性率

Effects of Minimally Invasive Surgical Treatment Through Anus on Complications and Gastrointestinal Function Recovery in Patients with Rectal Tumor/DUAN Xinxing， YU Xiong. //Medical Innovation of China， 2021， 18（31）： 0-075

[Abstract] Objective： To investigate the effect of minimally invasive surgical treatment through anus on complications and gastrointestinal function recovery in patients with rectal tumor. Method： A total of 98 patients with rectal tumor treated in our hospital from February 2019 to February 2020 were selected. They were divided into control group and study group according to different surgical treatment methods， with 49 patients in each group. The control group was treated with transanal resection， and the study group was treated with transanal endoscopic microsurgery （TEM）. The amount of intraoperative blood loss， operation time， postoperative complications， first exhaust time， first feeding time and negative rate of specimen margin were compared between the two groups. Result： The amount of intraoperative blood loss and operation time in the study group were lower than those in the control group （P<0.05）. The incidence of postoperative complications in the study group was lower than that in the control group （P<0.05）. The first exhaust time and first feeding time in the study group were shorter than those in the control group （P<0.05）. No residual tumor cells were found in the resection margin of all tumor lesion specimens in the two groups， that was， the negative rate of resection margin in both groups was 100%， and the difference was not statistically significant （P>0.05）. Conclusion： TEM can effectively reduce complications in patients with rectal tumor， promote the postoperative recovery of gastrointestinal function， and the negative rate of specimen margin is comparable to that of traditional surgical methods.

[Key words] Rectal tumor TEM Complications Gastrointestinal function Negative rate of resection margin

First-author’s address： Jiujiang First People’s Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2021.31.017

临床中一种较为常见、发病率较高的消化道肿瘤疾病就是直肠癌[1]。对直肠癌治疗的主要目标为治愈患者，缓解因为原发肿瘤病灶而导致出现的相关临床症状。但是临床中有很大一部分直肠癌患者在面对临床诊断时通常会因为害怕而拒绝接受临床治疗，原因主要为传统的根治性手术需要伴随永久性的结肠造口[2]。经肛门内镜显微手术（transanal endoscopic microsurgery，TEM）为近年来临床中新出现的一种经肛门检查及局部保肛治疗的手术方法[3]。其在临床当中的主要优点为对性功能及排便排尿影响较小、恢复快、手术创伤小等，特别是可以避免结肠造口，有效保留肛门括约肌功能，逐渐成为临床医生及患者关注的重点及热点[4]。……