低位直肠癌患者腹腔镜辅助经肛全直肠系膜切除术术后排便功能观察及其相关影响因素分析

Observation of Postoperative Defecation Function in Patients with Low Rectal Cancer Treated by Laparoscopic Assisted Transanal Mesorectal Excision

目的探讨腹腔镜辅助经肛全直肠系膜切除术(TaTME)治疗低位直肠癌患者术后排便功能及其相关影响因素。方法回顾性分析行腹腔镜辅助下TaTME术治疗的64例低位直肠癌患者的临床资料,分析腹腔镜辅助TaTME术后排便功能及其相关影响因素。结果64例患者术后3个月发生低位前切除综合征(LARS)40例(62.50%);有LARS组肿瘤直径≥5 cm、吻合口距肛缘距离<2 cm、肛门括约肌损伤比例高于无LARS组,差异有统计学意义(P<0.05);两组性别、体质量指数(BMI)、年龄、肿瘤分期、合并基础疾病和手术相关指标相比,差异无统计学意义(P>0.05);多因素分析显示,肿瘤直径≥5 cm、吻合口距肛缘距离<2 cm、肛门括约肌损伤是影响腹腔镜辅助TaTME术后排便功能的高危因素(OR>1,P<0.05)。结论腹腔镜辅助TaTME术后LARS发生率较高,其发生与肿瘤直径、吻合口距肛缘距离、肛门括约肌损伤密切相关,临床需加以重视。

Objective To investigate the postoperative defecation function of patients with low rectal cancer treated by laparoscopic-assisted transanal mesorectal excision(TaTME)and its related factors.Methods The clinical data of 64 patients with low rectal cancer treated by laparoscopic assisted TaTME were retrospectively analyzed,Analysis of laparoscopic assisted TaTME postoperative defecation function and related factors.Results 40 patients with low anterior resection syndrome(LARS)occurred 3 months after operation(62.50%);There were LARS groups with tumor diameter≥5 cm、anastomotic distance from anal margin<2,higher percentage of sphincter injury than no LARS group,difference was statistically significant(P<0.05);compared to the two groups of sex,body mass index(BMI),age,tumor stage,combined with basic diseases and surgical related indicators,(b)The difference was not statistically significant(P>0.05);Multivariate analysis showed,Tumor diameter≥5 cm,anastomotic distance from anal margin<2,sphincter injury were high risk factor(OR>1)affecting defecation function after laparoscopic assisted TaTME,P<0.05.Conclusion The incidence of LARS after laparoscopic assisted TaTME is high,Its occurrence is closely related to the diameter of the tumor,the distance from the anastomosis to the anal margin,and the injury of the anal sphincter,Clinical attention should be paid special attention.