拖出式结肠肛管延期吻合术对肛门功能的影响以及手术安全性的研究  

The impact of two-stage Turnbull-Cutait pull-through coloanal anastomosis on anal function and surgical safety in the treatment of low rectal cancer

作　　者：赵瀚潇 国瑀辰 何亮[1] 张路遥[1] 孙佳男 孙璇[1] 赵银泉 邢雁鹏 汪彦君 王美玲 巩阳 王权[1] Zhao Hanxiao;Guo Yuchen;He Liang;Zhang Luyao;Sun Jia'nan;Sun Xuan;Zhao Yinquan;Xing Yanpeng;Wang Yanjun;Wang Meiling;Gong Yang;Wang Quan(Department of Gastrocolorectal Surgery,General Surgery Center,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院普通外科中心胃结直肠外科,长春130021

出　　处：《中华普通外科杂志》2025年第2期101-107,共7页Chinese Journal of General Surgery

摘　　要：目的探讨拖出式结肠肛管延期吻合术(TCA)对术后短期内肛门功能的影响以及手术安全性。方法纳入2023年2月至2024年11月在吉林大学第一医院接受低位直肠癌手术治疗的102例患者,分为TCA手术组(50例)和直肠前切除联合预防造口还纳(LAR)手术组(52例)。结果TCA组的总体并发症发生率为44%。术后1、3、6个月患者重度LARS发生率分别为97%、77%、64%。两组术后30 d内并发症发生率差异无统计学意义(44%比38%,χ^(2)=0.135,P>0.05)。按照首次手术日期计算术后时间,TCA组术后第3个月和LAR组术后第4个月的重度LARS发生率差异无统计学意义(77%比69%,χ^(2)=0.202,P>0.05),两组术后第6个月的重度LARS发生率差异无统计学意义(64%比48%,χ^(2)=1.132,P>0.05)。结论TCA手术未增加患者术后30 d内并发症及半年内重度LARS风险。Objective:To explore the anal function and postoperative complications of 2-stage Turnbull-Cutait pull-through coloanal anastomosis(TCA)for low rectal cancer.Methods:Patients undergoing radical rectal cancer resection from Feb 2023 to Nov 2024 in the First Hospital of Jilin University were divided into the TCA surgery group and the low anterior resection combined with prophylactic stoma(LAR)surgery group.Results:Among the 102 patients,there were 50 cases in the TCA group and 52 cases in the LAR group.In the single-arm analysis of the TCA group,the overall complication rate was 44%.The incidence rates of severe LARS at 1 month,3 months,and 6 months after surgery were 97%,77%,and 64%respectively.There was no significant difference in the complication rate within 30 days after surgery between the two groups,(44%vs.38%,χ^(2)=0.135,P>0.05).There was no significant difference in the incidence rate of severe LARS between the TCA group and the LAR group(77%vs.69%,χ^(2)=0.202,P>0.05),and there was not significant difference in the incidence rate of severe LARS between the two groups at the 6th month after surgery,(64%vs.48%,χ^(2)=1.132,P>0.05).Conclusion:In patients who underwent TCA surgery,the LARS symptoms gradually decreased over time.Compared with patients undergoing low anterior resection and stoma reversal,there were no significant differences in complications within 30 days after surgery and LARS symptoms within half a year.

关 键 词：直肠肿瘤 吻合术 外科 综合征 肛门功能 肠造口 

分 类 号：R735.37[医药卫生—肿瘤]