经肛全直肠系膜切除术与腹腔镜全直肠系膜切除术后短期泌尿生殖系统功能研究现状  

Current status of research on short-term urogenital function after transanal total mesorectal excision and laparoscopic total mesorectal excision

作　　者：李昊泽 高加勒 姚宏伟[1] Li Haoze;Gao Jiale;Yao Hongwei(Department of General Surgery,National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究中心,北京100050

出　　处：《中华胃肠外科杂志》2022年第6期552-557,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研发计划资助(2017YFC0110904);北京市临床重点专科基金(卓越项目2018-118);首都卫生发展科研重点项目(首发2018-1-1111);首都医科大学结直肠肿瘤临床诊疗与研究中心基金(1192070313);首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016-5)。

摘　　要：受益于全新的手术入路途径,经肛全直肠系膜切除术(taTME)与腹腔镜全直肠系膜切除术(laTME)相比,尤其是对于男性、肥胖、骨盆狭窄或前列腺肥大的患者而言,手术视野更佳。尽管如此,taTME术后泌尿生殖系统功能及与之相关的生活质量是否优于laTME依然有待于进一步证实。在男性患者泌尿系症状方面,taTME相较于laTME没有显著优势,而且taTME术后尿路机械性损伤的发生率更高。目前,并没有研究对女性患者泌尿系症状及生活质量作详细阐述。taTME与laTME对男性患者术后性功能均有损害,随着术后恢复时间的延长,患者性功能会有不同程度好转,但两者相比差异并没有统计学意义。而在女性患者的性功能方面,taTME相比laTME更具有优势。目前,taTME与laTME术后短期泌尿生殖系统功能比较未见明显的差异,因此,taTME作为一种新的术式对术后泌尿生殖系统功能的影响是可以接受的。然而,taTME与laTME术后泌尿生殖功能是否有差别,有何差别,都有待于进一步研究。另外,患者功能学结果需要综合评定,且需完善术前基线资料评估,男性与女性的功能学评估应该分开进行,不能混为一谈。用于评价患者功能学结果的量表也需要验证其有效性。Thanks to the new surgical approach,transanal total mesorectal excision(taTME)has a better operative field exposure than laparoscopic-assisted total mesorectal excision(laTME),especially for male patients with obesity,pelvic stenosis or prostate hypertrophy.Nevertheless,whether the urogenital function and quality of life after taTME are better as compared to laTME requires further study.According to the existing studies,taTME and laTME are not significantly different in symptoms of the urology system for male patients,but some large sample clinical studies show that the incidence of urethral mechanical injury after taTME is higher.Unfortunately,there is no elaboration on that for females.The sexual function of male patients after taTME and laTME is both impaired.The sexual function of male patients will be relieved to different degrees over time,but there is no significant difference.Compared with laTME,taTME shows advantages in the sexual function for female patients.There is no significant difference in short-term urogenital system function between taTME and laTME at present.As a new surgical approach,the impact on urogenital system function after taTME is acceptable.However,whether there is a significant difference in urogenital function between taTME and laTME needs further research.In addition,functional results still need comprehensive evaluation,and preoperative baseline evaluation also needs to be enhanced.The functional evaluation for male and female should be carried out separately rather than confused.Questionnaire for evaluation of functional results also needs to be verified.

关 键 词：直肠肿瘤 经肛全直肠系膜切除术 腹腔镜全直肠系膜切除术 泌尿生殖系统功能 

分 类 号：R735.37[医药卫生—肿瘤]