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早期直肠癌局部切除术不同术式间的比较

A comparative study upon two surgical procedures of local resection of early rectal cancer

摘要:

目的 比较经肛门内镜显微手术(TEM)和Mason手术在早期直肠癌切除术中的应用.方法 将早期直肠癌患者按就诊时间段分为2组.2000年1月至2006年3月就诊患者接受Mason手术(26例);2006年4月至2011年7月就诊患者接受TEM手术(21例).Mason组患者和TEM组患者年龄、性别、术前TNM分期和瘤体直径差异无统计学意义,TEM组在肿瘤距肛缘的距离上高于Mason组.比较2组患者的手术安全性、术后并发症、术后恢复和肿瘤学疗效.结果 2组均无手术死亡病例.TEM组手术时间为(67±24) min,术中失血量(9±6) ml,显著少于Mason组[分别为( 102 ±40) min和(51±27) ml](t=3.526、7.078,P<0.05).TEM组术后下床时间、尿管留置时间、进食时间和住院天数分别为(1.3±0.5)、(1.2±0.4)、(1.5±0.5)和(4.3±1.6)d,显著短于Mason组[分别为(2.5±0.6)、(5.4±1.3)、(5.6±1.2)和(12.1±7.1)d](t=4.925 ~ 14.640,P<0.05).TEM组失访1例,平均随访时间36.5个月;Mason组平均随访时间81.6个月.2组3年无病生存率差异无统计学意义(TEM组:94.8%;Mason组:96.3%).结论 TEM技术用于早期直肠癌治疗具有良好的微创效果和理想的肿瘤学疗效.

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abstracts:

Objective To compare the application of transanal endoscopic microsurgery (TEM) technique with Mason's operation in the treatment of early rectal cancer. Methods Patients with early rectal cancer were divided into two groups according to different surgical procedures they underwent during different period.Patients in Mason Group underwent Mason's operations during the period from January 2000 to March 2006 ; and in TEM Group were managed with TEM procedures from April 2006 to July 2011.There were 21 patients in TEM Group and 26 patients in Mason Group.No statistically significant difference was found between the two groups in terms of patient's age,gender,preoperative TNM staging,and tumor diameter.In comparison with Mason Group,TEM Group had a longer distance of the tumor from the anal verge. The safety, postoperative complications, patients' postoperative recovery, and the oncological outcomes of 2 groups were compared with each other.Results No perioperative death occurred in the two groups.The TEM Group had notably shorter operating time ( (67 ± 24)minutes) and lesser intra-operative blood loss ( (9 ±6)ml) than Mason Group (t =3.526 and 7.078,P <0.05).The time of the postoperative bed rest,the urinary drainage,the recovery of oral intake,and the hospital stay in TEM Group were (1.3 ±0.5) days,(1.2 ±0.4) days,(1.5±0.5) days,and (4.3±1.6) days,respectively,and all were prominently shorter than those of Mason group (t =4.925-14.640,P < 0.05 ).Patients in TEM group were followed up for an average of 36.5 months with one patient being lost,while patients in Mason group were followed up for an average of 81.6 months. The difference between the two groups in terms of short-term accumulated survival ( 94.8% vs.96.3% ) showed no statistical significance ( P > 0.05 ).Conclusion TEM technique is a favorable minimally invasive procedure associated with satisfactory oncological outcomes in the treatment of early rectal cancer.

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