经肛门内镜微创手术优于经肛门切除直肠腺瘤。
Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas.
机构信息
Department of General Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands.
出版信息
Colorectal Dis. 2011 Jul;13(7):762-7. doi: 10.1111/j.1463-1318.2010.02269.x. Epub 2010 Mar 23.
AIM
Comparison of transanal excision (TE) and transanal endoscopic microsurgery (TEM) of rectal adenomas (RA) has rarely been performed.
METHOD
From 1990 to 2007, the results of TE (43 RA) and TEM (216 RA) were compared. Rectal adenomas were matched for diameter and distance from the anal verge.
RESULTS
Operation time was 47.5 min for TE and 35 min for TEM (P < 0.001). Morbidity was 10% after TE and 5.3% after TEM (P < 0.001). Negative resection margins were observed in 50% after TE and 88% after TEM (P < 0.001). Fragmentation of the excised specimen was observed in 23.8% after TE and 1.4% after TEM (P < 0.001). In cases of fragmentation, positive resection margins were observed more frequently. Recurrence was 28.7% after TE and 6.1% after TEM (P < 0.001). After TE, RA with a negative resection margin had a local recurrence rate of 0%, compared with 59.6% with a positive margin (P < 0.001), and after TEM these rates were 3.2 and 7.7% (P = 0.3), respectively.
CONCLUSION
Transanal endoscopic microsurgery is superior to transanal excision of RA.
目的
直肠腺瘤（RA）的经肛门切除（TE）与经肛门内镜显微手术（TEM）的比较很少进行。
方法
1990 年至 2007 年，对 TE（43 例 RA）和 TEM（216 例 RA）的结果进行了比较。直肠腺瘤的直径和距肛门缘的距离相匹配。
结果
TE 的手术时间为 47.5 分钟，TEM 为 35 分钟（P<0.001）。TE 的发病率为 10%，TEM 为 5.3%（P<0.001）。TE 后阴性切缘率为 50%，TEM 后为 88%（P<0.001）。TE 后有 23.8%的切除标本有碎片，TEM 后为 1.4%（P<0.001）。在有碎片的情况下，更常观察到阳性切缘。TE 后复发率为 28.7%，TEM 后为 6.1%（P<0.001）。TE 后，阴性切缘的 RA 局部复发率为 0%，而阳性切缘的 RA 局部复发率为 59.6%（P<0.001）；TEM 后这些比率分别为 3.2%和 7.7%（P=0.3）。
结论
TEM 优于 TE 切除 RA。
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