基于倾向性评分匹配的经肛全直肠系膜切除术与常规全直肠系膜切除术功能学预后的比较研究  

Comparative study of functional prognosis of transanal total mesorectal excision and conventional total mesorectal excision based on propensity score matching

作　　者：祝丽宇 赵世栋 申占龙[1] 叶颖江[1] 尹慕军[1] 杨晓东[1] 谢启伟[1] 姜可伟[1] 梁斌[1] 王杉[1] Zhu Liyu;Zhao Shidong;Shen Zhanlong;Ye Yingjiang;Yin Mujun;Yang Xiaodong;Xie Qiwei;Jiang Kewei;Liang Bin;Wang Shan(Department of Gastroenterological Surgery,Laboratory of Surgical Oncology,Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research,Peking University People′s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科北京大学人民医院外科肿瘤研究室北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华外科杂志》2020年第8期619-625,共7页Chinese Journal of Surgery

基　　金：国家重点研发计划(2017YFC1308800)。

摘　　要：目的比较直肠癌经肛全直肠系膜切除术(taTME)与常规全直肠系膜切除术(TME)的功能学预后。方法回顾性分析2015年1月至2019年12月北京大学人民医院胃肠外科49例行taTME和478例行常规TME的直肠癌患者的临床资料。应用倾向性评分匹配法对两组患者行1∶1匹配,成功匹配36对患者。匹配后taTME组、常规TME组患者年龄分别为60.5(16.0)、60.5(13.0)岁[M(QR)],男性患者比例分别为66.7%(24/36)、55.6%(20/36)。采用EORTC QLQ-C30量表评估生活质量,低位前切除综合征(LARS)量表联合Wexner便秘评分评估排便功能,国际前列腺功能评分(IPSS)评估排尿功能,国际勃起功能指数5(IIEF-5)及女性性功能指数(FSFI)评分分别评估男性和女性的性功能,广泛性焦虑障碍量表7(GAD-7)和患者健康问卷抑郁量表9(PHQ-9)评估心理状态。采用t检验、Mann-Whitney U检验、χ2检验、Fisher确切概率法进行组间比较,Wilcoxon秩和检验或McNemar检验进行配对资料的组间比较。结果taTME组和常规TME组患者手术时间、术后住院时间、中转开腹率、术后并发症发生率、手术费用、淋巴结清扫数目均无差异(P均>0.05)。taTME组出血量更多[100(100)ml比80(50)ml,U=424.5,P=0.010],预防性造口率更高[96.9%(31/36)比63.6%(21/36),χ2=11.218,P<0.01],住院总费用更低[74297.7(16746.4)元比91781.3(26228.4)元,U=413.0,P=0.008]。两组患者排便及排尿功能无明显差异(LARS量表评分:Z=-0.513,P=0.608;Wexner便秘评分:Z=-0.992,P=0.321;IPSS:Z=-1.807,P=0.071)。taTME组和常规TME组患者心理状态GAD-7评分有差异(Z=-2.311,P=0.021),具有广泛性焦虑障碍的患者分别占26.7%(8/30)和46.9%(15/32)。结论taTME较常规TME手术出血量及预防性造口率明显增加,但术后排便、排尿功能,以及性功能障碍发生率无明显差异,taTME在一定程度上减轻了患者的经济负担及广泛性焦虑障碍。Objective To compare the postoperative functional prognosis of transanal mesorectal excision(taTME)and conventional total mesorectal excision(TME)in rectal cancer.Methods Totally 49 patients underwent taTME and 478 patients underwent conventional TME at Department of Gastroenterological Surgery,Peking University People′s Hospital from January 2015 to December 2019 were retrospectively collected.Propensity score matching method was used to perform 1 versus 1 matching between the taTME and conventional TME groups,and 36 pairs of patients were successfully matched.After matching,the median age of patients in taTME group and conventional TME group was 60.5(16.0)years and 60.5(13.0)years(M(QR)),respectively,and the proportion of male patients was 66.7%(24/36)and 55.6%(20/36),respectively.EORTC QLQ-C30 scale was used to assess quality of life,low anterior resection syndrome(LARS)scale and Wexner constipation score were used to evaluate anal function,international prostate symptom score(IPSS)was used to evaluate urinary function,international index of erectile function(IIEF)-5 and female sexual function index(FSFI)score were used to evaluate male and female sexual function,respectively,and generalized anxiety disorder(GAD-7)and patient health questionnaire(PHQ-9)scale were used to evaluate psych function.The t test,Mann-Whitney U test,χ2 test,and Fisher exact test were used for comparison between groups,and Wilcoxon rank sum test or McNemar test was used for comparison between paired data.Results There were no significant differences in surgery time,postoperative hospital stays,conversion rate,morbidity rate,surgery cost,and numbers of lymph node yield between the two groups(all P>0.05).Compared with the conventional TME group,the intraoperative blood loss in the taTME group was significantly higher(100(100)ml vs.80(50)ml,U=424.5,P=0.010),the prophylactic stoma rate was significantly higher(96.9%(31/36)vs.63.6%(21/36),χ2=11.218,P<0.01),the total hospitalization cost was significantly lower(74297.7(16746.4)CNY vs.917

关 键 词：直肠肿瘤 排尿 性功能障碍 生理性 经肛全直肠系膜切除术 

分 类 号：R735.37[医药卫生—肿瘤]