机器人辅助全直肠系膜切除术与经肛全直肠系膜切除术的临床效果比较

Comparison of the clinical effects of robot-assisted total mesorectal excision and transanal total mesorectal excision

目的比较机器人辅助全直肠系膜切除术与经肛全直肠系膜切除术的应用效果。方法回顾性分析2021年1月至2023年6月于中国人民解放军北部战区总医院收治的58例低位直肠癌患者的临床资料,根据手术方式的不同,将患者分为机器人辅助全直肠系膜切除术组(n=27)和经肛全直肠系膜切除术组(n=31),比较两组的肿瘤学指标、安全性指标、肛门及泌尿功能指标。结果经肛全直肠系膜切除术组肿瘤远切缘距离较机器人辅助全直肠系膜切除术组近,差异有统计学意义(P<0.001)。经肛全直肠系膜切除术组有29例(93.5%)高质量系膜切除患者,机器人辅助全直肠系膜切除术组27例患者均为高质量系膜切除,比较差异无统计学意义(P=0.494)。两组在肿瘤最大直径、淋巴结清扫数目、肿瘤病理TNM分期方面比较差异无统计学意义(P>0.05)。所有患者均完成手术,未中转开腹,未进行术中输血。术后共有6例患者出现Clavien-DindoⅡ级并发症,其中经肛全直肠系膜切除术组4例,机器人辅助全直肠系膜切除术组2例,两组术后并发症发生率比较差异无统计学意义(P>0.05)。机器人辅助全直肠系膜切除术组有10例(37.0%)患者行预防性末段回肠造口术。两组手术时间、术中出血量及住院时间比较差异无统计学意义(P>0.05)。机器人辅助全直肠系膜切除术组术后Wexner肛门失禁评分、低位前切除综合征量表评分、国际前列腺症状评分高于经肛全直肠系膜切除术组,差异有统计学意义(P<0.05)。机器人辅助全直肠系膜切除术组男性术后国际尿失禁咨询委员会尿失禁量表评分高于经肛全直肠系膜切除术组,差异有统计学意义(P<0.05)。两组女性术后国际尿失禁咨询委员会尿失禁量表评分比较差异无统计学意义(P>0.05)。结论机器人辅助全直肠系膜切除术及经肛全直肠系膜切除术均为安全有效的治疗低位直肠癌的手段。经肛全直肠系膜切除术对肿瘤远切缘距离的确定更为精准,在保护男性泌尿功能方面有一定优势,但对术后肛门功能影响较大。

Objectives To compare the clinical effects of robot-assisted total mesorectal excision(RoTME)and transanal total mesorectal excision(taTME)in the treatment of low rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 58 patients with low rectal cancer admitted to the General Hospital of Northern Theater Command of the Chinese People’s Liberation Army from January 2021 to June 2023.Based on the surgical approach,patients were divided into the RoTME group(n=27)and the taTME group(n=31).Oncologic indicators,safety indicators,and anal and urinary function indicators were compared between the two groups.Results The distance of the distal resection margin was significantly closer in the taTME group compared to the RoTME group(P<0.001).High-quality mesorectal excision was achieved in 29 cases(93.5%)in the taTME group and all 27 cases in the RoTME group,with no statistically significant difference(P=0.494).No significant differences were observed between the two groups in terms of maximum tumor diameter,number of lymph nodes dissected,and pathological tumor node metastasis stage(P>0.05).All surgeries were completed without conversion to open surgery or intraoperative blood transfusion.Postoperative complications occurred in 6 patients,with 4 Clavien-Dindo gradeⅡcomplications in the taTME group and 2 in the RoTME group,showing no statistically significant difference in complication rates(P>0.05).Ten patients(37.0%)in the RoTME group underwent prophylactic end ileostomy.No significant differences were found in operative time,intraoperative blood loss,and hospital stay between the two groups(P>0.05).The postoperative Wexner incontinence score,low anterior resection syndrome(LARS)scores,and International Prostate Symptom Score(IPSS)in the RoTME group were higher than those in the taTME group,and the differences were statistically significant(P<0.05).The score of the International Consultation on Incontinence Modular Questionnaire on Male/Female Lower Urinary Tract Symptoms Scale(ICIQ-MLUTS/FLUTS)for males in the RoTME group was higher than that in the taTME group,and the difference was statistically significant(P<0.05).There was no statistically significant difference(P>0.05)in the scores of the ICIQ Scale between the two groups of women after surgery.Conclusion Both RoTME and taTME are safe and effective surgical options for low rectal cancer.taTME provides a more precise determination of the distal resection margin and may better preserve male urinary function,but it has a greater impact on postoperative anal function.