经肛门全直肠系膜切除术后功能学结果的研究进展

Research progress of functional outcomes secondary to transanal total mesorectal excision

目的探讨经肛门全直肠系膜切除术(TaTME)后的功能学结果。方法收集国内外有关TaTME后功能学研究的相关文献,对TaTME后功能学结果如生活质量、泌尿功能、性功能及排便功能的研究现状、存在的问题进行综述。结果生活质量方面,TaTME与腹腔镜TME的结果相似,均不会对患者造成严重影响;性功能方面,目前仅有少量的研究涉及到术后性功能,尚不能得出确切的结论,仅从目前的资料来看,TaTME不会对性功能造成严重的影响,与腹腔镜TME相比目前并未展现出优势;在泌尿功能与排便功能方面,与腹腔镜TME相比无明显差别,TaTME后患者泌尿功能与排便功能方面会受到一定程度的损害,排便功能障碍主要集中在术后1~6个月,但随着时间的推移,会得到一定程度的恢复。结论虽然TaTME在保护盆腔自主神经方面更有优势,但从目前研究结果来看,术后器官功能与腹腔镜TME手术相比并未有明显的差异,仍需要多中心、大样本和长期的随访研究来验证远期结果。

Objective To summarize the functional outcomes of transanal total mesorectal excision(TaTME).Method The literatures about functional outcomes and existing problems secondary to TaTME in China and abroad were collected to make a review. Results Neither the TaTME or the laparoscopic TME(LTME) had few serious impact on the quality of life of patients. At present, only a few studies were involved in the postoperative sexual function, and no definite conclusion could be drawn. From the current data only, the TaTME had few serious impact on the sexual function and it didn’t show some advantages as compared with the LTME. The urinary and defecation functions showed no obvious differences between the TaTME and the LTME, which of the patients after the TaTME might be impaired to some extent. The defecation disorders mainly occurred in 1-6 months after the TaTME, but it would recover to a certain extent as time went on. Conclusions Although TaTME has more advantages in protecting pelvic autonomic nerves, there is no obvious difference in postoperative organ function as compared with LTME surgery at present. Multi-center, large sample size, and long-term follow-up studies are still needed to validate long-term results.