手套通路经肛全直肠系膜切除术与传统术式在直肠癌根治术中的应用效果及对患者术后排便功能的影响

Application of glove access transanal total mesorectal excision and traditional surgery in radical resection of rectal cancer patients and the influencing factors of postoperative defecation function

目的探讨手套通路经肛全直肠系膜切除术(taTME)与传统术式在直肠癌根治术中的应用效果及对术后排便功能的影响。方法选取2017年3月-2021年4月该院收治的行直肠癌根治术的患者120例,分为手套通路taTME组(n=53)和传统手术组(n=67),比较两组患者的临床资料。观察术后3个月患者排便功能情况,根据术后是否出现排便功能障碍,将患者分为排便功能障碍组(n=34)和无排便功能障碍组(n=86)。对影响直肠癌根治术后发生排便功能障碍的相关因素进行单因素和多因素分析,筛选出影响术后排便功能的独立危险因素。结果手套通路taTME组术后疼痛情况、肿瘤远切缘和肿瘤下缘距肛缘距离均优于传统手术组(P<0.05)。排便功能障碍组体重指数(BMI)、肿瘤直径、术后吻合口距肛缘距离、同步放化疗、术中出血量和手术方式等因素与无排便功能障碍组比较,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示:肿瘤直径>5.0 cm(OR=1.879,95%CI:1.156~3.056)、术后吻合口距肛缘距离<2.0 cm(OR=3.367,95%CI:1.327~8.542)和手术方式(OR=4.536,95%CI:1.919~10.724)是影响直肠癌根治术后发生排便功能障碍的独立危险因素(OR>1,P<0.05)。结论手套通路taTME相比传统手术,虽然可获得更安全的远切缘,但术后排便功能障碍发生率更高。明确术后排便功能障碍发生的影响因素,并进行有效干预,不仅可提高手术效果,还能为术后排便功能障碍的防治提供指导依据。

Objective To explore and analyze the application of glove access transanal total mesorectal excision(taTME)and traditional surgical methods in radical resection of rectal cancer and the influencing factors of postoperative defecation function of patients.Methods 120 patients underwent radical rectal cancer surgery were selected from March 2017 to April 2021.Among them,53 patients were treated with glove access taTME,and 67patients were selected for traditional surgery,the clinical data of the two groups were compared.After 3 months of follow-up,the patients were followed up for postoperative defecation function.According to whether there was defecation dysfunction after operation,the patients were divided into defecation dysfunction group with 34 cases and no defecation dysfunction group with 86 cases.Single-factor 2-test analysis was performed on high-risk factors related to defecation dysfunction after radical resection of rectal cancer,and then multivariate Logistic regression analysis was performed to screen out independent factors affecting postoperative defecation function.Result Postoperative pain,distal resection margin of tumor and distance between lower margin of tumor and anal margin were all better in the glove access ta TME group than in the traditional operation group(P<0.05).There were significant differences in factors such as body mass index,tumor diameter,postoperative anastomotic distance from anal verge,concurrent chemoradiotherapy,intraoperative blood loss and surgical method compared with the group without defecation dysfunction(P<0.05).Multivariate Logistic regression analysis showed that tumor diameter>5.0 cm(OR=1.879,95%CI:1.156~3.056),postoperative anastomotic distance<2.0 cm(OR=3.367,95%CI:1.327~8.542)and surgical method(OR=4.536,95%CI:1.919~10.724)were rectal cancer independent risk factors for defecation dysfunction after radical resection(OR>1,P<0.05).Conclusion Compared with traditional surgery,glove access ta TME can achieve safer distal margins,but the incidence of postoperative defecation dysfunction is higher.Identifying the influencing factors of postoperative defecation dysfunction and carrying out effective intervention can not only improve the surgical effect,but also provide guidance for the prevention and treatment of postoperative defecation dysfunction.