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目的:探讨经肛门内镜显微外科(TEM)手术与传统腹会阴联合直肠癌根治(Miles)手术治疗直肠癌的临床效果差异。方法:选取手术治疗的127例直肠癌患者进行回顾性分析,其中53例患者采用TEM手术方法(TEM组),74例患者采用传统Miles手术治疗(传统组),对比两组患者的围手术期指标、术后免疫功能水平及手术并发症。结果:TEM组患者的手术时间、术中出血量、肛门排气时间、导尿管留置时间、住院时间均显著低于传统组患者且差异有统计学意义(P<0.05),两组患者的淋巴结清扫数目无统计学差异(P>0.05);术后TEM组患者的CD4~+、CD4~+/CD8~+及NK细胞水平均高于传统组(P<0.05);术后6个月,TEM组患者的躯体功能、角色功能、情绪功能、社会功能、整体功能均高于传统组(P<0.05),两组认知功能评分差异无统计学意义(P>0.05);TEM组患者的手术并发症11.32%与传统组的8.11%差异无统计学意义(P>0.05)。结论:TEM手术较传统Miles手术治疗直肠癌的优势主要为创伤小,术后恢复快,术后患者的生存质量较高,但是远期效果尚不清楚。
Objective: To investigate the clinical effect of transanal endoscopic microsurgery (TEM) surgery and conventional abdominal perineum combined with rectal cancer surgery on rectal cancer. Methods: A retrospective analysis was performed on 127 patients with rectal cancer treated by surgery. Among them, 53 patients underwent TEM surgery (TEM group) and 74 patients underwent traditional Miles surgery (traditional group). The perioperative period was compared between the two groups Indicators, postoperative immune function and surgical complications. Results: The operation time, intraoperative blood loss, anal exhaust time, urinary catheter indwelling time and hospital stay in TEM group were significantly lower than those in the traditional group (P <0.05). There was no significant difference between the two groups (P> 0.05). The levels of CD4 ~ +, CD4 ~ + / CD8 ~ + and NK cells in the TEM group were significantly higher than those in the traditional group (P <0.05) after 6 months (P <0.05). There was no significant difference in cognitive function score between the two groups (P> 0.05). The patients in TEM group had higher body function, role function, emotional function, social function and overall function than the traditional group The complications of 11.32% and 8.11% of the traditional group had no significant difference (P> 0.05). CONCLUSION: Compared with traditional Miles surgery, the advantages of TEM surgery in treating rectal cancer are small trauma, quick recovery after operation, and higher quality of life in postoperative patients. However, the long-term effect is not yet clear.