关键词: 经肛门内镜显微手术, 直肠良性肿瘤, 胃肠功能恢复, 并发症, 晚期氧化蛋白产物（AOPP）, 谷胱甘肽过氧化物酶（GSH-Px）

Abstract: Objective　To investigate the effect of transanal endoscopic microsurgery on postoperative gastrointestinal function recovery and serum advanced oxidized protein product (AOPP) and glutathione peroxidase (GSH-Px) levels in patients with benign rectal tumors. Methods　Seventy-three patients with benign rectal tumors treated at Lanshan District People's Hospital from August 2017 to August 2019 were selected for the prospective study and divided into a microsurgery group (37 cases) and a traditional surgery group (36 cases) according to a random number table. There were 22 males and 15 females in the microsurgery group, and they were (51.42±5.58) years old. There were 23 males and 13 females in the traditional surgery group, and they were (52.26±6.04) years old. The microsurgery group underwent transanal endoscopic microsurgery, and the traditional surgery group conventional surgery. The surgical conditions, surgical efficacies, incidences of complications, and serum levels of oxidative stress indicators (AOPP and GSH-Px), and gastrointestinal hormone indicators [serum motilin (MTL) and gastrin (GAs)] before and 1 and 3 days after the operation were compared between the two groups. The independent-sample t test, paired t test, and χ² test were applied. Results　The postoperative bowel sound recovery time, first anal flatus time, time to eat, and hospital stay were (5.17±0.94) h, (6.93±1.72) h, (29.31±5.28) h, and (3.42±0.81) d in the microsurgery group, which were shorter than those in the traditional group [(11.62±1.85) h, (15.70±2.14) h, (68.74±11.02) h, and (7.60±1.29) d], with statistical differences (t=18.855, 19.326, 19.579, and 16.629; all P<0.001). The intraoperative blood loss was (30.53±5.69) ml in the microsurgery group, and was (49.17±8.50) ml in the traditional surgery group, with a statistical difference (t=11.038, P<0.05). The total effective rate and the incidence of postoperative complications were 97.30% (36/37) and 8.11% (3/37) in the microsurgery group, and were 77.78% (28/36) and 27.78% (10/36) in the traditional surgery group, with statistical differences (χ²=4.753 and 4.823; both P<0.05). The serum AOPP levels 1 and 3 days after the operation were higher than those before the operation in the two groups, and were lower in the microsurgery group than in the traditional surgery group [(65.11±8.24) μmol/L vs. (102.58±16.70) μmol/L and (52.48±6.61) μmol/L vs. (78.12±10.23) μmol/L; t=12.208 and 12.754, both P<0.001]. The serum GSH-Px levels 1 and 3 days after the operation were lower than those before the operation in the two groups, and were higher in the microsurgery group than in the traditional surgery group [126.27±18.59) U/ml vs. (84.91±12.52) U/ml and (141.10±22.73) U/ml vs. (104.58±19.65) U/ml; t=11.118 and 7.335 both P<0.001]. The serum levels of MTL and GAs 3 days and 1 week after the operation were lower than those before the operation in both groups, and were higher in the microsurgery group than in the traditional surgery group [(228.17±19.53) pg/ml, (254.50±22.47) pg/ml, (66.35±5.48) μmol/L, and (71.41±6.34) μmol/L vs. (181.25±15.58) pg/ml, (203.56±20.52) pg/ml, (61.43±4.91) μmol/L, and (66.45±5.39) μmol/L], with statistical differences (t=11.328, 10.106, 4.036, and 3.597; all P<0.001). Conclusion　Compared with traditional surgery, transanal endoscopic microsurgery for benign rectal tumors can improve the treatment effect, reduce surgical trauma, promote postoperative gastrointestinal function recovery, and reduce the occurrence of complications, and has little effect on serum AOPP and GSH-Px levels, and the body's oxidative stress response is mild.

Key words: Transanal endoscopic microsurgery, Benign rectal tumors, Gastrointestinal function recovery, Complications, Advanced oxidized protein product (AOPP), Glutathione peroxidase (GSH-Px)