经肛腔镜括约肌间切除术在低位直肠癌保肛中的应用价值  

Application value of transanal endoscopic intersphincteric resection in sphincter preserva-tion for low rectal cancer

作　　者：曹高健 徐玺谟 钟昊 蔡正昊 尤俊[3] 任明扬[4] 康亮[5] 冯波[2] Cao Gaojian;Xu Ximo;Zhong Hao;Cai Zhenghao;You Jun;Ren Mingyang;Kang Liang;Feng Bo(Department of Gastrointestinal Surgery,The Third Affiliated Hospital of Wenzhou Medical University,Wenzhou 325200,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Gastrointestinal Oncology,The First Affiliated Hospital of Xiamen University,Xiamen 361003,China;Department of Gastrointestinal Surgery,Nanchong Central Hospital,North Sichuan Medical College,Nanchong 637003,China;Department of General Surgery(Colorectal Surgery),The Sixth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510655,China)

机构地区：[1]温州医科大学附属第三医院胃肠外科,温州325200 [2]上海交通大学医学院附属瑞金医院普外科,上海200025 [3]厦门大学附属第一医院胃肠外科,厦门361003 [4]川北医学院附属南充市中心医院胃肠外科,南充637003 [5]中山大学附属第六医院普通外科(结直肠外科),广州510655

出　　处：《中华消化外科杂志》2024年第6期836-844,共9页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82373237);转化医学国家重大科技基础设施(上海)项目(TMSK-2021-503)。

摘　　要：目的探讨经肛腔镜括约肌间切除术(taE-ISR)在低位直肠癌保肛中的应用价值。方法采用倾向评分匹配及回顾性队列研究方法。收集2017年1月至2021年12月上海交通大学医学院附属瑞金医院等5家医学中心收治的278例低位直肠癌患者的临床病理资料;男178例,女100例;年龄为58(49~64)岁。278例患者中,147例行taE-ISR,设为taE-ISR组,131例行经括约肌间切除术(ISR),设为ISR组。观察指标:(1)倾向评分匹配前及匹配后两组患者一般资料比较。(2)两组患者术中及术后结果比较。(3)两组患者长期随访结果。(4)影响低位直肠癌保肛的独立影响因素。倾向评分匹配按1∶1最近邻匹配法匹配,卡钳值为0.05。倾向评分匹配分析采用"Matching"包进行。正态分布的计量资料以x±s进行表示,组间比较采用Student′st检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Wilcoxon秩和检验。计数资料以绝对数或百分比表示,组间比较采用Pearsonχ^(2)检验或Fisher确切概率法。采用Kaplan-Meier法计算生存率并绘制生存曲线,Log-Rank检验进行生存分析。多因素分析采用Logistic回归模型,使用"glm2"包进行,森林图显示影响低位直肠癌保肛的风险因素。结果(1)倾向评分匹配情况及匹配后两组患者一般资料比较。278例患者中,180例配对成功,taE-ISR组和ISR组各90例。倾向评分匹配后消除坐骨结节间径、坐骨结节至臀部皮肤距离因素混杂偏倚,具有可比性。(2)两组患者术中及术后结果比较。taE-ISR组患者远切缘阳性1例,标本质量完整88例,完成保肛88例。ISR组患者远切缘阳性8例、标本质量完整78例、完成保肛74例。两组患者上述指标比较,差异均有统计学意义(P<0.05)。(3)两组患者长期随访结果。taE-ISR组和ISR组患者的中位随访时间分别为4.3(3.8~5.0)年和4.1(3.4~4.7)年。taE-ISR组患者总生存率为100.0%,无病生存率为95.6%,累积复发率为2.2Objective To investigate the application value of transanal endoscopic inter-sphincteric resection(taE-ISR)in sphincter preservation for low rectal cancer.Methods The pro-pensity score matching and retrospective cohort study was conducted.The clinicopathological data of 278 patients with low rectal cancer who were admitted to 5 medical centers,including Ruijin Hospital of Shanghai Jiaotong University School of Medicine etal,from January 2017 to December 2021 were collected.There were 178 males and 100 females,aged 58(range,49-64)years.Of 278 patients,147 cases undergoing taE-ISR were divided into the taE-ISR group,and 131 cases undergoing intersphincteric resection(ISR)were divided into the ISR group.Observation indicators:(1)propen-sity score matching and comparison of general data of patients between the two groups after matching;(2)comparison of intraoperative and postoperative conditions between the two groups;(3)long-term follow-up of the two groups;(4)analysis of risk factors affecting sphincter preservation for low rectal cancer.Propensity score matching was done by the 1:1 nearest neighbor matching method,with a caliper value of 0.05.Propensity score matching analysis was done using the Matching package.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the Student's t test.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and comparison between groups was conducted using the Wilcoxon rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the Pearson chi-square test or Fisher exact probability.The Kaplan-Meier method was used to calculate survival rate and plot survival curve,and the Log-Rank test was used for survival analysis.Multivariate analysis was conducted using the Logistic regression model with the"glm2"package.The forest plot was used to show the risk factors affecting sphincter preser-vation for low rectal cancer.Results(1)Propens

关 键 词：直肠肿瘤 经肛腔镜 括约肌间切除术 保肛 疗效 

分 类 号：R735.37[医药卫生—肿瘤]