经肛门内镜显微手术治疗大肠腺瘤的疗效分析
Analysis of the therapeutic effect of transanal endoscopic microsurgery on large rectal adenoma.
作者信息
Zhang Yongbo, Yu Peng, Wang Peng, Jiao Mingwen, Liu Yulin, Xu Kang, Liu Xiang, Yang Hui, Xia Lijian, Chen Jingbo
机构信息
Department of General Surgery, The First Affiliated Hospital of Shandong, First Medical University and Shandong Provincial Qianfoshan Hospital, Key Laboratory of Metabolism and Gastrointestinal Tumor, The First Affiliated Hospital of Shandong, First Medical University, Key Laboratory of Laparoscopic Technology, The First Affiliated Hospital of Shandong First Medical University, Shandong Medicine and Health Key Laboratory of General Surgery, Jinan, China.
Department of Gastrointestinal Surgery, The Second People's Hospital of Lianyungang, Lianyungang, Jiansu Province, China.
出版信息
J Minim Access Surg. 2022 Oct-Dec;18(4):571-577. doi: 10.4103/jmas.jmas_273_21.
PURPOSE
Rectal adenoma, a pre-cancerous lesion, is one of the indications for transanal endoscopic microsurgery (TEM). TEM has its unique advantages in the treatment of rectal adenomas. However, there are few reports on the therapeutic effects of large rectal adenoma (LRA). The objective of this study was to investigate the value of TEM in the treatment of LRA.
MATERIALS AND METHODS
We collected data from patients who underwent surgery at our center from 2007 to 2017. The postoperative pathology of all patients was rectal adenoma and the diameter of the adenoma was 3 cm or greater. Moreover, all patients underwent TEM. We followed up to observe the incidence of no wound healing, rectal stenosis and recurrence rate of rectal adenoma. The risk factors of adenoma recurrence and wound healing were analysed using single- and multiple-factor analysis.
RESULTS
The clinicopathological data of 85 patients with LRA were collected through a pre-set table. During the follow-up period, eight patients were lost to follow-up, and three (3.90%) patients developed rectal stenosis. After 2 years of post-operative follow-up, 20 (25.97%) patients had recurrence and 57 (74.03%) patients had no recurrence. Multivariate analysis showed that positive margin was an independent risk factor for recurrence of adenoma.
CONCLUSIONS
TEM is feasible in the treatment of large rectal tumours in Centers of Expertise with the technique.
目的
直肠腺瘤作为一种癌前病变，是经肛门内镜显微手术（TEM）的适应证之一。TEM在直肠腺瘤的治疗中具有独特优势。然而，关于大型直肠腺瘤（LRA）治疗效果的报道较少。本研究的目的是探讨TEM在LRA治疗中的价值。
材料与方法
我们收集了2007年至2017年在本中心接受手术治疗患者的数据。所有患者术后病理均为直肠腺瘤，腺瘤直径为3 cm或更大。此外，所有患者均接受了TEM治疗。我们进行随访以观察无伤口愈合、直肠狭窄的发生率以及直肠腺瘤的复发率。采用单因素和多因素分析方法分析腺瘤复发和伤口愈合的危险因素。
结果
通过预设表格收集了85例LRA患者的临床病理数据。随访期间，8例患者失访，3例（3.90%）患者发生直肠狭窄。术后随访2年，20例（25.97%）患者复发，57例（74.03%）患者未复发。多因素分析显示，切缘阳性是腺瘤复发的独立危险因素。
结论
在具备该技术的专业中心，TEM治疗大型直肠肿瘤是可行的。
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