TAMIS与传统术式治疗直肠肿瘤效果的临床对比研究
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摘要
目的比较经肛门微创(TAMIS)与传统术式治疗直肠肿瘤效果的临床效果。方法 2016年1月～2017年9月,在邢台市第三医院住院接受直肠肿瘤局部切除的患者100例,根据手术方法的不同分为观察组与对照组各50例。观察组行TAMIS术式,对照组行传统手术治疗,记录两组近远期预后。结果两组患者术后病理标本的切缘均未发现肿瘤细胞残留,标本切缘阴性率均为100%。观察组肿瘤距肛门距离平均为7.83±3.61cm,对照组为3.94±1.33cm,观察组多于对照组(t=9.834,P<0.05)。两组手术时间与术中出血量比较,差异无统计学意义(P>0.05),观察组术后住院时间与术后胃肠道恢复时间低于对照组(P<0.05)。观察组术后1个月的尿潴留、出血、切口裂开、大便失禁等并发症发生率为2.0%,对照组为20.0%,观察组低于对照组(P<0.05)。所有患者都得到随访,两组的无病生存率和总生存率比较,差异无统计学意义(P>0.05)。结论相对于传统术式,TAMIS与治疗直肠肿瘤效果可将直肠中下段肿瘤的局部切除,肿瘤切除切缘阳性率低,能促进患者康复,降低术后并发症的发生,且不会增加患者的病死率。
Objective To compare the clinical effect of transanal minimally invasive treatment(TAMIS) and traditional surgical treatment of rectal cancer. Methods From January 2016 to September 2017, 100 patients received local resection of rectal tumor patients in the Third Hospital of Xingtai City were selected. All the patients were divided into the observation group and control group of 50 patients in each group according to the different surgical methods. The observation group was given TAMIS operation group, and the control group was underwent conventional surgical treatment, recorded two groups of short and long term prognosis. Results There were no residual tumor cells found in the incisal edge of the pathological specimens in the two groups, and the negative rates in the incisal margin was 100%. The distance between the tumor and the anus was 7.83±3.61 cm in the observation group, so that was 3.94±1.33 cm in the control group, and the observation group was more than that in the control group(t=9.834, P<0.05). There were no significant differences compared between the two groups in the operation time and intraoperative blood loss(P>0.05). The postoperative hospital stay and postoperative gastrointestinal recovery time in the observation group were lower than those in the control group(P<0.05). The postoperative 1 month incidence of complications such as urinary retention, bleeding, incision dehiscence, fecal incontinence in the observation group was 2%, so that was 20% in the control group, and the observation group was lower than that of the control group(P<0.05). All patients were followed up. There were no significant difference in disease-free survival and overall survival times compared between the two groups(P>0.05). Conclusion Compared with traditional surgery, TAMIS in the treatment of rectal tumor can be local rectal tumor resection, and its tumor resection margin positive rate is low. It can promote the rehabilitation of patients, reduce the incidence of postoperative complications, and does not increase the mortality of patients.
Objective To compare the clinical effect of transanal minimally invasive treatment(TAMIS) and traditional surgical treatment of rectal cancer. Methods From January 2016 to September 2017, 100 patients received local resection of rectal tumor patients in the Third Hospital of Xingtai City were selected. All the patients were divided into the observation group and control group of 50 patients in each group according to the different surgical methods. The observation group was given TAMIS operation group, and the control group was underwent conventional surgical treatment, recorded two groups of short and long term prognosis. Results There were no residual tumor cells found in the incisal edge of the pathological specimens in the two groups, and the negative rates in the incisal margin was 100%. The distance between the tumor and the anus was 7.83±3.61 cm in the observation group, so that was 3.94±1.33 cm in the control group, and the observation group was more than that in the control group(t=9.834, P<0.05). There were no significant differences compared between the two groups in the operation time and intraoperative blood loss(P>0.05). The postoperative hospital stay and postoperative gastrointestinal recovery time in the observation group were lower than those in the control group(P<0.05). The postoperative 1 month incidence of complications such as urinary retention, bleeding, incision dehiscence, fecal incontinence in the observation group was 2%, so that was 20% in the control group, and the observation group was lower than that of the control group(P<0.05). All patients were followed up. There were no significant difference in disease-free survival and overall survival times compared between the two groups(P>0.05). Conclusion Compared with traditional surgery, TAMIS in the treatment of rectal tumor can be local rectal tumor resection, and its tumor resection margin positive rate is low. It can promote the rehabilitation of patients, reduce the incidence of postoperative complications, and does not increase the mortality of patients.
引文
1 张昌越,肖冰.69例直肠神经内分泌肿瘤临床特点及内镜下诊疗分析[J].现代消化及介入诊疗,2017,22(1):20-23
2 李宁,梁建伟,金晶,等.442例Ⅰ期直肠癌患者的临床病理特征及预后因素分析[J].中国临床医生杂志,2017,45(6):29-33
3 Plummer JM,Leake PA,Albert MR.Recent advances in the management of rectal cancer:no surgery,minimal surgery or minimally invasive surgery[J].World J Gastrointest Surg,2017,9(6):139-148
4 Lee BC,Oh S,Lim SB,et al.Transanal minimally-invasive surgery for treating patients with regressed rectal cancer after preoperative chemoradiotherapy[J].Ann Coloproctol,2017,33(2):52-56
5 Mao W,Liao X,Shao S,et al.Comparative evaluation of colonoscopy-assisted transanal minimally invasive surgery via glove port and endoscopic submucosal dissection for early rectal tumor[J].Int J Surg,2017,7(42):197-202
6 申占龙,叶颖江,谢启伟,等.经肛门微创手术在直肠肿瘤中的应用前景[J].中华胃肠外科杂志,2015,22(5):419-422
7 García-Flórez LJ,Otero-Díez JL,Encinas-Muňiz AI,et al.Indications and outcomes from 32 consecutive patients for the treatment of rectal lesions by transanal minimally invasive surgery[J].Surg Innov,2017,24(4):336-342
8 Melin AA,Kalaskar S,Taylor L,et al.Transanal endoscopic microsurgery and transanal minimally invasive surgery:is one technique superior?[J].Am J Surg,2016,212(6):1063-1067
9 Burke JP,Martin-Perez B,Khan A,et al.Transanal total mesorectal excision for rectal cancer:early outcomes in 50 consecutive patients[J].Colorectal Dis,2016,18(6):570-577
10 de Graaf EJ,de Graaf JJ,Schot I,et al.TAMIS of a rectal haemangioma - a video vignette[J].Colorectal Dis,2016,18(11):1110-1119
11 Atallah S.Utilization of the TAMIS technique for trans-stomal excision of a colonic neoplasm:a video demonstration[J].Tech Coloproctol,2016,20(11):779-780
12 Trépanier JS,Fernandez-Hevia M,Lacy AM.Transanal total mesorectal excision:surgical technique description and outcomes[J].Minim Invasive Ther Allied Technol,2016,25(5):234-240
13 陈宁,陈庆琳,徐静.直肠肿瘤经肛微创手术(TAMIS)的护理配合[J].实用临床医药杂志,2015,19(24):231-232
14 Atallah S,Albert M,Monson JR.Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME):toward the mastery of a new operation for rectal cancer surgery[J].Tech Coloproctol,2016,20(7):483-494
15 Foo DC,Choi HK,Wei R,et al.Transanal total mesorectal excision with single-Incision laparoscopy for rectal cancer[J].JSLS,2016,20(2):99-105
16 何流,肖毅.经肛门全直肠系膜切除术在直肠癌根治中的应用[J].中华胃肠外科杂志,2017,20(8):957-960
17 Marks JH,Montenegro GA,Salem JF,et al.Transanal TATA/TME:a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer[J].Tech Coloproctol,2016,20(7):467-473
18 Sumrien H,Dadnam C,Hewitt J,et al.Feasibility of transanal minimally invasive surgery (TAMIS) for rectal tumours and its impact on quality of life-the bristol series[J].Anticancer Res,2016,36(4):2005-2009
19 Hasegawa S,Okada T,Hida K,et al.Transperineal minimally invasive approach for extralevator abdominoperineal excision[J].Surg Endosc,2016,30(10):4620-4621
20 Haugvik SP,Groven S,Bondi J,et al.A critical appraisal of transanal minimally invasive surgery (TAMIS) in the treatment of rectal adenoma:a 4-year experience with 51 cases[J].Scand J Gastroenterol,2016,51(7):855-859
21 Chouillard E,Regnier A,Vitte RL,et al.Transanal notes total mesorectal excision (TME) in patients with rectal cancer:is anatomy better preserved?[J].Tech Coloproctol,2016,20(8):537-544
22 胡黎明,王仁启.远端切缘长度的选择对行直肠癌切除术患者预后的影响[J].现代医药卫生,2017,33(10):1529-1531
23 魏志平,应荣彪,姚俊,等.经肛门微创手术治疗直肠肿瘤疗效分析[J].中国基层医药,2017,24(12):1782-1785
2 李宁,梁建伟,金晶,等.442例Ⅰ期直肠癌患者的临床病理特征及预后因素分析[J].中国临床医生杂志,2017,45(6):29-33
3 Plummer JM,Leake PA,Albert MR.Recent advances in the management of rectal cancer:no surgery,minimal surgery or minimally invasive surgery[J].World J Gastrointest Surg,2017,9(6):139-148
4 Lee BC,Oh S,Lim SB,et al.Transanal minimally-invasive surgery for treating patients with regressed rectal cancer after preoperative chemoradiotherapy[J].Ann Coloproctol,2017,33(2):52-56
5 Mao W,Liao X,Shao S,et al.Comparative evaluation of colonoscopy-assisted transanal minimally invasive surgery via glove port and endoscopic submucosal dissection for early rectal tumor[J].Int J Surg,2017,7(42):197-202
6 申占龙,叶颖江,谢启伟,等.经肛门微创手术在直肠肿瘤中的应用前景[J].中华胃肠外科杂志,2015,22(5):419-422
7 García-Flórez LJ,Otero-Díez JL,Encinas-Muňiz AI,et al.Indications and outcomes from 32 consecutive patients for the treatment of rectal lesions by transanal minimally invasive surgery[J].Surg Innov,2017,24(4):336-342
8 Melin AA,Kalaskar S,Taylor L,et al.Transanal endoscopic microsurgery and transanal minimally invasive surgery:is one technique superior?[J].Am J Surg,2016,212(6):1063-1067
9 Burke JP,Martin-Perez B,Khan A,et al.Transanal total mesorectal excision for rectal cancer:early outcomes in 50 consecutive patients[J].Colorectal Dis,2016,18(6):570-577
10 de Graaf EJ,de Graaf JJ,Schot I,et al.TAMIS of a rectal haemangioma - a video vignette[J].Colorectal Dis,2016,18(11):1110-1119
11 Atallah S.Utilization of the TAMIS technique for trans-stomal excision of a colonic neoplasm:a video demonstration[J].Tech Coloproctol,2016,20(11):779-780
12 Trépanier JS,Fernandez-Hevia M,Lacy AM.Transanal total mesorectal excision:surgical technique description and outcomes[J].Minim Invasive Ther Allied Technol,2016,25(5):234-240
13 陈宁,陈庆琳,徐静.直肠肿瘤经肛微创手术(TAMIS)的护理配合[J].实用临床医药杂志,2015,19(24):231-232
14 Atallah S,Albert M,Monson JR.Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME):toward the mastery of a new operation for rectal cancer surgery[J].Tech Coloproctol,2016,20(7):483-494
15 Foo DC,Choi HK,Wei R,et al.Transanal total mesorectal excision with single-Incision laparoscopy for rectal cancer[J].JSLS,2016,20(2):99-105
16 何流,肖毅.经肛门全直肠系膜切除术在直肠癌根治中的应用[J].中华胃肠外科杂志,2017,20(8):957-960
17 Marks JH,Montenegro GA,Salem JF,et al.Transanal TATA/TME:a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer[J].Tech Coloproctol,2016,20(7):467-473
18 Sumrien H,Dadnam C,Hewitt J,et al.Feasibility of transanal minimally invasive surgery (TAMIS) for rectal tumours and its impact on quality of life-the bristol series[J].Anticancer Res,2016,36(4):2005-2009
19 Hasegawa S,Okada T,Hida K,et al.Transperineal minimally invasive approach for extralevator abdominoperineal excision[J].Surg Endosc,2016,30(10):4620-4621
20 Haugvik SP,Groven S,Bondi J,et al.A critical appraisal of transanal minimally invasive surgery (TAMIS) in the treatment of rectal adenoma:a 4-year experience with 51 cases[J].Scand J Gastroenterol,2016,51(7):855-859
21 Chouillard E,Regnier A,Vitte RL,et al.Transanal notes total mesorectal excision (TME) in patients with rectal cancer:is anatomy better preserved?[J].Tech Coloproctol,2016,20(8):537-544
22 胡黎明,王仁启.远端切缘长度的选择对行直肠癌切除术患者预后的影响[J].现代医药卫生,2017,33(10):1529-1531
23 魏志平,应荣彪,姚俊,等.经肛门微创手术治疗直肠肿瘤疗效分析[J].中国基层医药,2017,24(12):1782-1785