Abstract:

Objective　To explore the effect of transanal endoscopic submucosal dissection (ESD) in the treatment of patients with early rectal cancer. Methods　Ninety-two patients with early rectal cancer treated at Xuchang Longyao Hospital from August 2020 to August 2022 were selected and were divided into a transanal group and a laparoscopic according to the therapeutic methods, with 46 cases in each group. There were 25 males and 21 females in the transanal group; they were (57.88±5.03) years old; their body mass index was (22.51±1.55) kg/m²; their longest tumor diameter was (2.46±0.31) cm. There were 23 males and 23 females in the laparoscopic group; they were (58.22±5.34) years old; their body mass index was (22.69±1.71) kg/m²; their longest tumor diameter was (2.51±0.33) cm. The transanal group took transanal ESD, and the laparoscopic group laparoscopic surgery. The perioperative indicators, postoperative recovery, and levels of inflammatory indicators [interleukin (IL)-6, IL-8, C-reactive protein (C-reactive protein, CRP)] and tumor markers [carcinoembryonic antigen (CEA) and carbohydrate antigen 724 (CA724)] before and after the surgery and prognosis in both groups were observed. The count data were analyzed by χ² test, and the measurement data t test. Results　The operation time and intraoperative bleeding volume in the transanal group were less than those in the laparoscopic group [(59.43±5.22) min vs. (82.77±7.35) min and (30.58±4.31) ml vs. (59.79±8.44) ml], with statistical differences (t=17.560 and 20.905; both P<0.001). The postoperative exhaust time, first feeding time, and hospital stay in the transanal group were shorter than those in the laparoscopic group [(1.85±0.32) d vs. (2.21±0.41) d, (2.01±0.28) d vs. (2.35±0.37) d, and (4.75±0.69) vs. (5.48±0.72) d], with statistical differences (t=4.695, 4.970, and 4.965; all P<0.001). The serum levels of CRP, IL-6, and IL-8 24 and 72 h after the surgery in the transanal group were lower than those in the laparoscopic group [(39.58±5.42) mg/L vs. (44.76±6.13) mg/L, (58.19±5.62) ng/L vs. (63.77±7.18) ng/L, (56.79±4.53) ng/L vs. (60.48±4.42) ng/L, (24.55±4.39) mg/L vs. (28.47±5.13) mg/L, (49.35±4.01) ng/L vs. (55.73±5.24) ng/L, and (40.28±4.32) ng/L vs. (48.76±4.11) ng/L], with statistical differences (t=4.294, 4.151, 3.954, 3.938, 6.558, and 9.646; all P<0.001). One year after the surgery, the levels of CEA and CA724 in the transanal group were lower than those in the laparoscopic group [(5.35±1.08) μg/L vs. (5.83±1.11) μg/L and (3.62±0.54) IU/ml vs. (3.88±0.58) IU/ml], with statistical differences (t=2.102 and 2.225; P=0.038 and 0.029). One year after the surgery, there was no statistical difference in the recurrence rate between the two groups [0 vs. 4.35% (2/46); χ²=0.511, P=0.474]. Conclusion　Transanal ESD in the treatment of patients with early rectal cancer can optimize the operation, reduce blood loss and inflammatory reaction, improve their digestive function, and shorten their postoperative recovery process, and their prognosis is good.

Key words:

Rectal cancer, Endoscopic mucosal decollement, Laparoscopic surgery, Inflammatory factors, Tumor markers, Prognosis

摘要：

目的　探究经肛门内镜下黏膜剥离术（endoscopic submucosal dissection，ESD）治疗早期直肠癌患者的效果。方法　选取2020年8月至2022年8月许昌龙耀医院收治的92例早期直肠癌患者，根据治疗方法将其分为经肛组和腹腔镜组，各46例。经肛组男25例，女21例，年龄（57.88±5.03）岁，体质量指数（22.51±1.55）kg/m²，肿瘤长径（2.46±0.31）cm；腹腔镜组男23例，女23例，年龄（58.22±5.34）岁，体质量指数（22.69±1.71）kg/m²，肿瘤长径（2.51±0.33）cm。经肛组实施经肛门ESD治疗，腹腔镜组采用腹腔镜手术治疗。观察两组围手术期指标、术后恢复情况、术前与术后炎性指标［白细胞介素-6（interleukin-6，IL-6）、IL-8、C反应蛋白（C-reactive protein，CRP）］、肿瘤标志物［癌胚抗原（carcinoembryonic antigen，CEA）、糖类抗原724（carbohydrate antigen，CA724）］及预后情况。计数资料采用χ²检验，计量资料采用t检验。结果　经肛组手术时间、术中出血量分别为（59.43±5.22）min、（30.58±4.31）ml，均少于腹腔镜组的（82.77±7.35）min、（59.79±8.44）ml，差异均有统计学意义（t=17.560、20.905，均P<0.001）。经肛组术后排气时间、首次进食时间与住院天数分别为（1.85±0.32）d、（2.01±0.28）d、（4.75±0.69）d，均短于腹腔镜组的（2.21±0.41）d、（2.35±0.37）d、（5.48±0.72）d，差异均有统计学意义（t=4.695、4.970、4.965，均P<0.001）。经肛组血清CRP、IL-6、IL-8水平术后24 h分别为（39.58±5.42）mg/L、（58.19±5.62）ng/L、（56.79±4.53）ng/L，术后72 h分别为（24.55±4.39）mg/L、（49.35±4.01）ng/L、（40.28±4.32）ng/L，均低于腹腔镜组［术后24 h：（44.76±6.13）mg/L、（63.77±7.18）ng/L、（60.48±4.42）ng/L；术后72 h：（28.47±5.13）mg/L、（55.73±5.24）ng/L、（48.76±4.11）ng/L］，差异均有统计学意义（t=4.294、4.151、3.954、3.938、6.558、9.646，均P<0.001）。术后1年，经肛组CEA、CA724水平分别为（5.35±1.08）μg/L、（3.62±0.54）IU/ml，低于腹腔镜组的（5.83±1.11）μg/L、（3.88±0.58）IU/ml，差异均有统计学意义（t=2.102、2.225，P=0.038、0.029）。术后1年，两组复发率比较，差异无统计学意义［0比4.35%（2/46）；χ²=0.511，P=0.474］。结论　经肛门ESD治疗早期直肠癌患者能优化手术，降低出血量和减轻炎症反应，改善患者消化功能，缩短患者术后恢复进程，患者预后良好。

关键词:

直肠癌, 内镜下黏膜剥离术, 腹腔镜手术, 炎症因子, 肿瘤标志物, 预后