Lin Guo-Le, Meng William C S, Lau Patrick Y Y, Qiu Hui-Zhong, Yip Andrew W C
Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Asian J Surg. 2006 Oct;29(4):227-32. doi: 10.1016/S1015-9584(09)60093-2.
To compare local resection of early rectal tumours by transanal endoscopic microsurgery (TEM) and the conventional posterior trans-sphincteric approach (Mason's operation).
The study group comprised 31 consecutive patients with early rectal tumours (18 villous adenomas, 13 adenocarcinomas) who underwent TEM in Kwong Wah Hospital, Hong Kong. The control group consisted of 51 patients with early rectal tumours (27 villous adenomas, 24 adenocarcinomas) who underwent Mason's operation in Peking Union Medical College Hospital, Beijing. Outcome measures included morbidity and mortality, operation time, recurrence rate and postoperative pathological staging.
Age, sex and pathological staging were similar in the two groups. The tumour size, operation time and blood loss were similar. The median distance from the anal verge was significantly higher in the TEM group (TEM/Mason = 8.0/6.4 cm, p = 0.042). The postoperative resumption of food intake (TEM/Mason = 1/5 days, p = 0.002) and the median hospital stay (TEM/Mason = 4/10 days, p = 0.005) were significantly shorter in the TEM group. Analgesic intake was significantly less in the TEM group (TEM/Mason = 0/100 mg, p = 0.0003). There was no operation-related mortality and the resection margins were clear in both groups. Two patients (3.9%) in the Mason's group developed postoperative wound infection, and two patients (3.9%) developed faecal fistulae. There was one secondary haemorrhage in the TEM group that required injection sclerotherapy. On median follow-up of 23 months, there was no tumour recurrence in the TEM group, whereas two patients (3.9%) in the Mason's group experienced recurrence during a median follow-up of 30 months.
TEM is as effective as the conventional posterior trans-sphincteric approach (Mason's operation) for local curative resection of early rectal tumours. TEM is less invasive, with shorter hospital stay and fewer complications than conventional Mason's operation.
比较经肛门内镜显微手术（TEM）与传统经括约肌后入路（梅森手术）对早期直肠肿瘤的局部切除术。
研究组包括31例连续的早期直肠肿瘤患者（18例绒毛状腺瘤，13例腺癌），他们在香港广华医院接受了TEM手术。对照组由51例早期直肠肿瘤患者（27例绒毛状腺瘤，24例腺癌）组成，他们在北京协和医院接受了梅森手术。观察指标包括发病率和死亡率、手术时间、复发率和术后病理分期。
两组患者的年龄、性别和病理分期相似。肿瘤大小、手术时间和失血量相似。TEM组距肛缘的中位距离显著更高（TEM/梅森手术=8.0/6.4 cm，p=0.042）。TEM组术后恢复进食时间（TEM/梅森手术=1/5天，p=0.002）和中位住院时间（TEM/梅森手术=4/10天，p=0.005）明显更短。TEM组的镇痛药物摄入量明显更少（TEM/梅森手术=0/100 mg，p=0.0003）。两组均无手术相关死亡，切缘均清晰。梅森手术组有2例患者（3.9%）发生术后伤口感染，2例患者（3.9%）发生粪瘘。TEM组有1例继发性出血，需要注射硬化剂治疗。中位随访23个月时，TEM组无肿瘤复发，而梅森手术组在中位随访30个月时有2例患者（3.9%）复发。
TEM在早期直肠肿瘤的局部根治性切除方面与传统经括约肌后入路（梅森手术）同样有效。与传统的梅森手术相比，TEM的侵入性更小，住院时间更短，并发症更少。
