腹腔镜下全直肠系膜切除术联合经肛直肠拖出术对低位直肠癌患者肛门功能影响  

Effect of laparoscopic total mesenterectomy combined with trans-anorectal extraction on anal function in patients with low rectal cancer

作　　者：杨学文 高峰[2] 李孟斌 Yang Xuewen;Gao Feng;Li Mengbin(Department of Digestive Surgery,the First Affiliated Hospital of Air Fore Medical University,Xi'an Shaanxi Province 710032,China;Department of General Surgery,Shanxi Provincial People's Hospital,Xi'an Shaanxi Province 710068,China)

机构地区：[1]空军军医大学第一附属医院消化外科,西安710032 [2]陕西省人民医院普外科,西安710068

出　　处：《中华普外科手术学杂志（电子版）》2022年第4期435-438,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2019年陕西省医药卫生科技计划项目(20190474)。

摘　　要：目的探讨经肛门全直肠系膜切除术(TaTME)联合经肛直肠拖出术(Bacon)对低位直肠癌患者肛门功能影响。方法回顾性队列研究2018年5月至2020年5月接受治疗的89例低位直肠癌患者临床资料,根据不同术式分为两组,即为Bacon组(n=47例,腹腔镜下TaTME联合Bacon)和常规组(n=42例,腹腔镜下TaTME联合常规结肠肛管吻合)。采用SPSS 23.0软件进行处理数据,围手术期相关指标、大便失禁评分指数(FISI)、大便失禁生活质量问卷(FIQL)评分以(x±s)表示,采用独立样本t检验;术后并发症用[n(%)]表示,行χ^(2)检验。P<0.05为差异有统计学意义。结果两组患者手术时间、术中出血量、淋巴结清扫数量及术后下床活动时间对比,差异均无统计学意义(P>005);Bacon组患者住院时间较常规组长(P<0.05);Bacon组患者术后12个月的FISI较常规组低,FIQL评分比常规组高,术后并发症总发生率(6.4%)低于常规组(21.4%),差异有统计学意义(P<0.05)。结论腹腔镜下TaTME联合Bacon术应用于低位直肠癌患者的治疗中可降低术后并发症的发生,改善肛门功能及生活质量,值得推广应用。Objective To investigate the effect of total anal mesenterectomy(TaTME)combined with anal rectal extraction(Bacon)on anal function in patients with low reetal eancer.Methods A retrospective cohort study was conducted on the clinical data of 89 patients with low rectal cancer who received treatment from May 2018 to May 2020.They were divided into two groups according to different surgical procedures.Bacon group(n=47 cases,TaTME combined with Bacon)and Routine group(n=42 cases,TaTME combined with conventional colon anal canal anastomosis).SPSS 23.0 software was used for data analysis.Perioperative related indicators,fecal incontinence score Index(FISI),fecal incontinenee Quality of Life Questionnaire(FIQL)score were represented by(x±s),and independent sample t test was used.Postoperative complications were expressed by[n(%)]and χ^(2) test was performed.P<0.05 was considered statistically significant.Results There were no significant differences in operative time,intraoperative blood loss,lymph node dissection number and postoperalive ambulation time between 2 groups(P>0.05).The length of hospital stay in Bacon group was longer than conventional group(P<0.05).12 months afer surgery,FISI and FIQL scores of patients in the Bacon group were lower than those in the conventional group,and the total incidence of postoperative complications(6.4%)was lower than that in the conventional group(21.4%),with statistically significant differences(P<0.05).Conclusion The application of TaTME combined with Bacon.surgery in the treatment of patients with low rectal cancer can reduce the oecurrence of postoperative complications and improve anal function and quality of life,which is worthy of popularization and application.

关 键 词：低位直肠癌 腹腔镜 全直肠系膜切除术 经肛直肠拖出术 肛门功能 

分 类 号：R73[医药卫生—肿瘤]