腔镜直线切割吻合器用于T1期中低位直肠癌经肛门局部切除术的疗效及安全性

目的:探讨应用腔镜直线切割吻合器（endoscopic linear cutters，ENDOPATH）行经肛门局部切除术治疗T1期中低位直肠癌的疗效和安全性。方法:回顾性分析2011年01月至2017年12月我院收治的92例T1期中低位直肠癌患者的临床资料。根据手术方式分为经肛门局部切除术组（TAE组）与直肠癌传统根治术组（根治术组）。TAE组使用腔镜直线切割吻合器行经肛门全层局部切除术，共39例；根治术组按全直肠系膜切除原则行传统根治术，共53例(包括16例Miles手术和37例Dixon手术)。对两组患者的一般资料、术中及术后相关指标及预后情况进行比较。结果:TAE组和根治术组患者在性别、年龄、肿瘤病理分型、肿瘤大小、距肛缘距离方面对比分析，无显著性差异（P＞0.05），两组资料有可比性。两组患者在手术时间［（TAE组:(37.74±10.66)min，根治术组:(117.66±41.78)min］、术后住院时间［TAE组:(6.85±1.06)天，根治术组:(10.70±1.72)天］、术中出血量［TAE组:(30.21±2.97)mL，根治术组:(78.96±12.65)mL］、术后并发症发生率（TAE组:2.56%，根治术组:43.39%）方面差异均有统计学意义（P＜0.01)。两组患者的3年无病生存率均为100.00%，两组患者3年内均无复发，相比较无统计学差异（P＞0.05）。两组患者的生存质量评分［TAE组:(90.31±3.82)分，根治术组:（71.59±6.33）分］差异有统计学意义（P＜0.01)。结论:与传统根治术相比，应用腔镜直线切割吻合器对T1期中低位直肠癌行经肛门局部切除术同样安全有效。应用腔镜直线切割吻合器行经肛门局部切除术创伤小、并发症少、恢复快，患者术后生活质量等方面明显优于根治术。应用腔镜直线切割吻合器行经肛门局部切除术可作为早期无淋巴转移的中低位直肠癌患者优先选择的一种术式。

The safety and efficacy of transanal local excision with endoscopic linear cutters for the treatment of T1 stage mid-low rectal cancer

Objective:To investigate the clinical efficacy and safety of transanal local excision with endoscopic linear cutters(ENDOPATH) among T1 stage mid-low rectal cancer patients.Methods:92 patients admitted with T1 stage mid-low rectal cancer in our hospital were collected from January 2011 to December 2017.According to the surgical methods,patients were divided into transanal local excision group(TAE group) and traditional radical therapy group(radical group).39 patients in the TAE group underwent transanal full-thickness local excision with ENDOPATH.53 patients in the radical group underwent conventional radical surgery according to the principle of total mesorectal excision,including 16 patients with Miles and 37 patients with Dixon.Comparative analyses of basic materials,intraoperative and postoperative indicators,and prognosis status were performed between the two groups.Result:The TAE group and radical group had no significant differences in gender,age,postoperative pathological types,tumor size,and tumor distance from the anal verge(P＞0.05).General characteristic of patients were comparable between the two groups.The two groups had significant differences in operation time［TAE group:(37.74±10.66)min,radical group:(117.66±41.78)min］,postoperative hospital stay［TAE group:(6.85±1.06)days,radical group:(10.70±1.72)days］,intraoperative bleeding volume［TAE group:(30.21±2.97)mL,radical group:(78.96±12.65)mL］,and the rate of postoperative complications(TAE group:2.56%,radical group:43.39%)(P＜0.01).In both groups,the 3-year disease-free survival was 100.00% and there was no recurrence.There was no statistical differences between the two groups(P＞0.05).The two groups had significant differences in the score of survival quality［TAE group:（90.31±3.82）scores,radical group:(71.59±6.33)scores］(P＜0.01).Conclusion:For T1 stage mid-low rectal cancer cases,transanal local excision with ENDOPATH may achieve the same clinical efficacy and safety as conventional radical surgery.Compared with the conventional radical surgery,transanal local excision with ENDOPATH has obvious advantages of less trauma,fewer surgical complications,quicker recovery and higher living quality.Transanal local excision with ENDOPATH may be a preferentially selective for no lymph metastasis in early mid-low rectal cancer.