经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后肛门功能的比较

Comparison of anal function between transanal total mesorectal excision and laparoscopic total mesorectal excision

目的探索与传统腹腔镜全直肠系膜切除术(lap-TME)相比,经肛全直肠系膜切除术后(TaTME)的肛门功能情况。方法回顾收集2015年1月至2018年3月在北京大学人民医院胃肠外科施行的直肠癌全直肠系膜切除术患者资料40例,其中TaTME组20例,lap-TME组20例,用直肠低位前切除综合征(LARS)评分量表比较lap-TME与TaTME两组患者术后的肛门功能。结果 TaTME组与lap-TME组相比,术中出血量、手术时间、淋巴结清扫数目、术后住院天数、远切缘和环周切缘等方面差异均无统计学意义(均P>0.05)。术后3个月内TaTME组LARS总评分和各项评分均显著高于lap-TME组(均P<0.05)。术后1个月两组患者在排气控制和稀便漏出两项问题中的得分差异存在统计学意义(均P<0.05),术后2个月、3个月两组患者在排气控制、稀便漏出与排便后1小时内再次排便三项问题差异均存在统计学意义(均P<0.05)。两组患者在排便次数和排便急迫问题上差异无统计学意义(P>0.05)。结论在术后早期,接受TaTME手术患者的肛门功能可能差于lap-TME患者,但随着术后时间的延长,经过适当的功能锻炼,TaTME术后肛门功能可在一定程度上得到改善。

ObjectiveTo compare the anal function between rectal cancer patients underwent TaTME and lap-TME. MethodsForty cases of rectal cancer were collected retrospectively in Peking University People′s Hospital from January 2015 to March 2018. Each group has 20 cases. Postoperative clinicopathological indicators and defecation function of patients were compared between lap-TME group and TaTME group. ResultsBetween two group, there were no significant statistical difference in blood loss, operative time, lymph nodes harvested, postoperative hospital stay, distant resection margin, and circumferential resection margin （P 〉 0.05）. Within three months after surgery, the low anterior resection syndrome score of the lap-TME group was signi？cantly lower than that of the TaTME group （P 〈 0.05）. One month after surgery, comparing between lap-TME group and TaTME group, there were significant difference in the score of exhaust control and fecal leakage （P〈 0.05）. Two months and three months after surgery, there was signi？cant statistical difference in the score of the questions about exhaust control, fecal leakage, defecation again after defecation within 1 hour （P 〈 0.05）. There was no signi？cant difference in the frequency and urgency of defecation between the two groups （P 〉 0.05）. ConclusionAnal functionof patient underwent TaTME procedure was worse than those underwent lap-TME in early period post-operation, but which might be improved in some extent as the time goes on.