【作者】 赵天成；

【导师】 张斌；

【作者基本信息】 吉林大学 ， 外科学， 2012， 硕士

【摘要】 直肠腺瘤性息肉（rectal adenomatous polypus）已被询证医学证实为直肠癌前病变。规范合理的治疗直肠腺瘤性息肉，通过手术切除防止癌变，是降低直肠癌发病率的最佳方案。目前常用的直肠腺瘤性息肉的手术切除方法主要包括内镜息肉切除术，经肛门内镜下显微外科手术和经肛息肉局部切除术。在临床治疗中，三种术式的适应症和禁忌症基本相似且无统一的选择指南；现有文献中尚缺乏对三种术式的比较研究。为了探讨三种手术方法的疗效、并发症及手术、住院时间、医疗费用的不同，寻找出疗效较佳、并发症较少、对患者创伤较少且使患者经济负担较小的根治方法。本研究回顾性收集了2009年-2011年间于吉林大学第一、二、三院行内镜息肉切除术，经肛门内镜下显微外科手术及经肛息肉局部切除术的直肠腺瘤性息肉患者的临床资料，对三组术式患者的手术疗效，术中术后并发症的发生率，平均手术、住院时间及住院总费用等进行了比较研究。经统计分析，内镜息肉切除术、经肛门内镜下显微外科手术、经肛息肉局部切除术均能有效切除直肠腺瘤性息肉，切除成功率较高；内镜微创治疗术能切除距肛周距离较远的息肉；其术中的并发症较经肛息肉局部切除术少；平均手术时间、平均住院时间较TEM术及经肛息肉局部切除术短；手术总费用较TEM术和经肛息肉局部切除术少。通过本研究，全面对比分析了临床现用的三种直肠腺瘤性息肉的手术方法，为医务工作者和患者科学、理性的选择有效、安全、经济的治疗方法提供专业信息和参考。更多还原

【Abstract】 Introduction:Rectal adenomatous polypus has been demonstrated as the one of rectal precancerous diseases by a large number of clinical studies. In accordance with the theory of "adenoma-carcinoma" sequence and correlative evidence based medicine, the rate of rectal carcinoma can be reduced by the resection of rectal adenoma. The main surgical local resections include endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection. Generally speaking, there is lack of the contrastive research for surgical effect, complications and the cost among the three manners although their indications and contraindications are approximately similar. My study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies from No.l, No.2and No.3hospital attached to the Jilin University in the past two years. And it makes a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the cost totally.Objective:Through statistical analysis, a contrastive research among the three resectional manners by effect of operation, rate of complications, average time of surgery or being in bed and the total cost could show pros and cons of the three therapies in an objective point of view. Depending on it, maybe we can establish a standardization for the local resectional therapy of rectal adenomatous polypus.Materials and Methods:This study retrospectively collected the samples of rectal adenomatous polypus who took the three local resectional therapies (endoscopic resection, transanal endoscopic microsurgery and transanal local resection) from the No.l, No.2and No.3hospital attached to the Jilin University in the past two years (2009-2011). The samples can be classified into three groups based on the different surgical therapies, and in the followed text we call them endoscopic group, TEM group and transanal group for abbreviation. Each group has65. Statistically analyze the three groups of patients by the common information (age> gender), basic adenomatous data before operation (distance between tumor and anus> diameter of tumor and pathological classification), effect of operation (success rate> rate of complications), average time of surgery or being in bed and the total cost.Results:We can see that, in the common information, there is no statistical significant difference in distribution of age and gender among the three groups (P>0.05). In the basic adenomatous data before operation, there is no statistical significant difference in distribution of tumor’s pathological classification and tumor’s diameter among the three groups (P>0.05), and the difference of distance from adenoma to anus between the endoscopic group and the transanal group has statistical significance (P=0.005). The distance in endoscopic group is upper than the transanal group. And the difference has no statistical significance in other groups (P>0.05). From the comparison of success rate of different resectional manners, it shows that there is no statistical significant difference among the three groups (P>0.05). The comparison of intraoperative complications indicates that the difference of intraoperative bleeding between the transanal group and the endoscopic group has statistical significance (P=0.015). The bleeding in the transanal group is more than the endoscopic group. And the difference has no statistical significance in other groups (P>0.05). There is no intraoperative perforation in all the three groups. And the difference of rate of postoperative bleeding and perforation has no statistical significance among the three methods. Through the statistical analysis of average operative time of the three local resections, the endoscopic group took the less time than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average operative time between the TEM group and transanal group. In the comparison of average time of being in hospital, time in endoscopic group is less than both the TEM group and transanal group (P<0.001). And there is no statistical significant difference in average time of being in hospital between the TEM group and transanal group. Finally, we take a comparison of total cost among the three local resectional methods, and it shows that the endoscopic group costs less than the other groups. The difference has statistical significance (P<0.001)Conclusion:Endoscopic resection, transanal endoscopic microsurgery (TEM) and transanal local resection, all of the three methods could make an effective resection upon the samples who have the diagnosis of rectal adenomatous polypus. And the success rate of them is high. However, we also see the advantages of the endoscopic resection through the correlative statistical analysis. Endoscopic resection can treat with the adenoma which is more far from anus and has less intraoperative bleeding. The average time of operation and being in hospital in the endoscopic group is the least of all, and the cost for treatment is also the least.更多还原