腹部无辅助切口经肛门取标本的腹腔镜下低位直肠前切除术(CRC-NOSESⅠ式C法)对低位直肠癌患者术后控便功能及生活质量的影响

Effect of transanal natural orifice specimen extraction after laparoscopic low anterior rectal resection(CRC-NOSES Type ⅠC surgery) on anal function and quality of life in patients with low rectal cancer

目的探讨腹部无辅助切口经肛门取标本的腹腔镜下低位直肠前切除术(CRC-NOSESⅠ式C法)对低位直肠癌患者术后控便功能及生活质量的影响。方法选取2017年5月至2019年5月我院收治的68例低位直肠癌患者为研究对象,采用随机数字表法分为对照组和观察组,每组各34例。对照组予以常规腹腔镜直肠癌根治术(LCR)治疗,观察组予以腹部无辅助切口经肛门取标本的腹腔镜下低位直肠前切除术(CRC-NOSESⅠ式C法)治疗,比较两组手术相关指标、术后并发症发生率、氧化应激指标【超氧化物歧化酶(SOD)、丙二醛(MDA)】水平、肛门功能及生活质量。结果两组手术时间、术中出血量及术后并发症发生率比较差异均无统计学意义(均P>0.05),观察组肛门排气时间及术后住院时间均短于对照组(均P<0.05)。术前,两组氧化应激指标水平比较差异均无统计学意义(均P>0.05)。术后第3天,两组的MDA水平均高于术前,SOD水平均低于术前,差异均有统计学意义(均P<0.05);观察组的MDA水平低于对照组,SOD水平高于对照组,差异均有统计学意义(均P<0.05)。术前,两组肛门功能指标比较差异均无统计学意义(均P>0.05)。术后3个月,两组的肛管缩榨压与术前比较差异均无统计学意义(均P>0.05),肛管平均静息压及最大静息压均低于术前,Wexner评分高于术前,差异均有统计学意义(均P<0.05);观察组的肛管平均静息压、最大静息压高于对照组,Wexner评分低于对照组,差异均有统计学意义(均P<0.05)。两组肛管缩榨压比较差异无统计学意义(P>0.05)。观察组生理机能、生理职能、躯体疼痛、精神健康及一般健康状况评分均高于对照组,差异有统计学意义(均P<0.05),两组情感职能、社会功能及精力评分比较差异均无统计学意义(均P>0.05)。结论CRC-NOSESⅠ式C法治疗低位直肠癌较LCR创伤更小,对患者术后控便功能影响小,可改善患者生活质量。

Objectives To investigate the effect of transanal natural orifice specimen extraction after laparoscopic low anterior rectal resection(CRC-NOSES Type ⅠC surgery)on anal function and quality of life in patients with low rectal cancer.Methods Sixty-eight patients with low rectal cancer treated in our hospital between May 2017 and May 2019 were recruited and randomly assigned to the treatment group and control group with 34 patients in each group.Patients in the control group received routine laparoscopic resection for rectal cancer,and those in the treatment group received CRC-NOSES Type ⅠC surgery.The followings were compared between the two groups:surgical parameters,the incidence of postoperative complications,serum levels of oxida⁃tive stress indicators[superoxide dismutase(SOD)and malondialdehyde(MDA)],anal function,and quality of life.Results There were no significant differences between the two groups in duration of surgery,intraoperative blood loss,and the incidence of post⁃operative complications(P>0.05),but time to first bowel movement and length of postoperative hospitalization were significantly shorter in the treatment group(P<0.05).Preoperative levels of oxidative stress indicators were comparable between the two groups(P>0.05).At 3 days postoperative,the MDA level increased significantly,and the SOD level decreased significantly in both groups compared with preoperative levels(P<0.05).The MDA level was significantly lower and the SOD level was significantly higher in the treatment group(P<0.05).Preoperative anal function did not differ between the two groups(P>0.05).At 3 months after surgery,the mean and maximum anal resting pressure were significantly lower and Wexner score was significantly higher than their respective preoperative levels(P<0.05),anal systolic pressure remained at the preoperative level(P>0.05).Mean and maximum anal resting pressures were significantly higher,and Wexner score was significantly lower in the treatment group(P<0.05),anal systolic pressure was similar between the two groups(P>0.05).The scores of physical function,role-physical,bodily pain,mental health,and general health were significantly higher in the treatment group than in the control group(P<0.05),there were no significant differences in role-emotional,social function,and vitality between the two groups(P>0.05).Conclusion CRC-NOSES Type ⅠC surgery is less invasive for low rectal cancer.It has little impact on patients’anal function and improves patients’quality of life.