腹腔镜经肛提肌外腹会阴联合切除术对低位直肠癌病人泌尿生殖功能和生活质量影响研究

The impact on urogenital function and quality of life of laparoscopic extralevator abdominoperineal excision for low rectal cancer patients

目的比较腹腔镜经肛提肌外腹会阴联合切除术(ELAPE)与传统腹会阴联合切除术(APE)对低位直肠癌病人术后泌尿生殖功能及生活质量的影响。方法回顾性分析2015年1月至2020年4月首都医科大学附属北京朝阳医院普通外科收治的行腹腔镜ELAPE或APE的92例低位直肠癌病人的临床资料,其中ELAPE 60例(65.2%),APE 32例(34.8%)。采用国际前列腺症状评分(IPSS)和国际勃起功能指数(IIEF-5)评估病人的泌尿生殖功能,欧洲癌症研究与治疗组织生活质量核心问卷30(EORTC QLQ-C30)和结直肠癌病人专用生存质量问卷29(QLQ-CR29)评估生活质量。结果ELAPE组和APE组病人在年龄、性别、基础疾病、术后并发症、淋巴结清扫数目、肿瘤分期、肿瘤分化情况、系膜切除质量、脉管浸润和神经侵犯方面差异无统计学意义(P>0.05)。两组在术前泌尿生殖功能和生活质量评分方面差异亦无统计学意义(P>0.05)。与APE组相比,ELAPE组盆底重建率显著增高(76.7%vs.0,P<0.001)。两组病人术后IIEF-5评分差异无统计学意义[14(11~17)分vs.17(11~20.5)分,P=0.422],ELAPE组术后IPSS评分显著低于APE组[3(2~5)分vs.2(1~4)分,P=0.039]。两组泌尿功能障碍分级差异无统计学意义(P>0.05)。EORTC QLQ-C30结果显示,ELAPE组病人术后躯体功能显著优于APE组[86.7(73.3~93.3)分vs.70.0(60.0~85.0)分,P=0.005]。结论对于低位直肠癌,与腹腔镜APE相比,腹腔镜ELAPE术后病人泌尿功能较差,而对术后生殖功能和生活质量无明显影响。

Objective To compare the impacts on urogenital function and quality of life of laparoscopic extralevator(ELAPE)and conventional abdominoperineal excision(APE)for low rectal cancer patients.Methods data of 92 patients who received ELAPE or APE for low rectal cancer in the General Surgery Department of Beijing Chaoyang Hospital from January 2015 to April 2020 were collected and analyzed retrospectively,including 60(65.2%)patients in ELAPE group and 32(34.8%)in APE group.IPSS and IIEF-5 were applied to evaluate the urogenital function of patients over 12 months.EORTC QLQ-C30 and QLQ-CR29 questionnaire were used to assess the quality of life of patients.Results postoperative complications,lymph nodes acquisition,tumor staging,tumor differentiation,quality of mesorectal excision,vascular invasion and perineural invasion(P>0.05).There was no significant difference in preoperative urogenital function and quality of life between the two groups(P>0.05).Compared with APE group,the pelvic floor reconstruction rate in ELAPE group was significantly higher(76.7%vs.0,P<0.001).There was no significant difference existed in postoperative IIEF-5 score between the two groups[14(11~17)vs.17(11~20.5),P=0.422].The patients in the ELAPE group got worse IPSS score[3(2~5)vs.2(1~4),P=0.039]than those in the APE group significantly,while there were no significant differences in the grade of urinary dysfunction between the two groups(P>0.05).The EORTC QLQ-C30 score results revealed that the physical function of patients in ELAPE group was better than that in APE group[86.7(73.3-93.3)vs.70.0(60.0-85.0),P=0.005].Conclusion ELAPE is associated with reduced urinary function for patients with low rectal cancer after surgery compared with APE,but it has no significant effect on postoperative reproductive function and quality of life.