经肛微创手术（TAMIS）与经肛内镜显微手术（TEM）在直肠肿瘤局部切除中的应用优劣分析

目的比较经肛微创手术（TAMIS）与经肛内镜显微手术（TEM）行直肠肿瘤局部切除的近远期疗效。 方法采用回顾性队列研究的方法。收集2012年4月至2021年6月陆军军医大学大坪医院收治的52例直肠肿瘤患者的临床资料。其中26例行TEM手术的患者设为TEM组,26例行TAMIS手术的患者设为TAMIS组。比较两组的一般资料、围手术期指标、并发症情况及无病生存期等数据。 结果两组患者性别、年龄、美国麻醉医师协会分级、肿瘤距肛缘距离、肿瘤直径、肿瘤病理类型的比较,差异均无统计学意义（P＞0.05）。所有患者均顺利完成手术,无术中并发症。TEM组手术时间及出血量分别为（80.9±39.0）min,（22.0±23.7）mL;TAMIS组手术时间及出血量分别为（90.0±27.0）min,（24.8±20.7）mL,两组患者上述指标比较,差异无统计学意义（t=-0.960,-0.449;P＞0.05）。TEM组无术后并发症发生,TAMIS组有1例患者术后出现盆腔感染,经抗感染治疗后出院。两组患者术后首次肛门排气时间、术后首次进清流质饮食时间、术后住院时间比较差异无统计学意义（t=0.610,-1.091,-1.675;P＞0.05）。所有患者的术后病理结果提示手术切缘、基底部均未见肿瘤细胞残留。TEM组有1例直肠腺瘤患者在术后1年出现局部复发,予以肠镜下切除后未再复发。TAMIS组有1例早期直肠癌患者在术后8个月出现肝、肺转移。TEM组与TAMIS组3年无病生存率分别为95.5%和93.8%,两组比较差异无统计学意义（χ²=0.108,P=0.742）。 结论TAMIS手术行直肠肿瘤局部切除安全可行,可取得与TEM手术相似的近远期临床疗效。

Analysis of the advantages and disadvantages of transanal minimally invasive surgery and transanal endoscopic microsurgery in local resection of rectal tumors

ObjectiveTo compare the short-term and long-term efficacy of transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) in local resection of rectal tumors. MethodsThe retrospective cohort study was conducted. The clinical data of 52 patients with rectal tumors who were admitted to Daping Hospital of Army Military Medical University from April 2012 to June 2021 were collected. Twenty-six patients undergoing TEM surgery were allocated to the TEM group, and 26 patients undergoing TAMIS were allocated to the TAMIS group. General data, perioperative indicators, complications and disease-free survival were compared between the two groups. ResultsThere were no significant differences in gender, age, American society of anesthesiologists classification, tumor distance from anal margin, tumor diameter and pathological type between the two groups (P＞0.05). All patients successfully completed the operation without intraoperative complications. The operative time and blood loss in TEM group were (80.9±39.0) min and (22.0±23.7) mL, respectively. The operation time and blood loss in TAMIS group were (90.0±27.0) min and (24.8±20.7) mL, respectively. There was no significant difference in the above indexes between the two groups (t=-0.960, -0.449; P＞0.05). No postoperative complications occurred in the TEM group. In the TAMIS group, one patient developed pelvic infection after operation, and was discharged successfully after anti-infection treatment. There were no significant differences in the time to first flatus, time of first clear-fluid diet and the length of postoperative hospital stay between the two groups (t=0.610,-1.091,-1.675;P＞0.05). Pathological examination confirmed that the surgical margin and basal margin of all patients were negative. In the TEM group, one patient with rectal adenoma had local recurrence 1 year after surgery. In the TAMIS group, one patient with early rectal cancer developed liver and lung metastasis 8 months after surgery. The 3-year disease-free survival rates of the TEM group and the TAMIS group were 95.5% and 93.8%, respectively, and there was no significant difference between the two groups (χ²=0.108, P=0.742). ConclusionTAMIS is safe and feasible for local resection of rectal tumor, and has similar short-term and long-term oncological outcome as TEM.