A Study For The Therapy Of The Rectal Adenomatous Polypus By Three Local Resection

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.