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中华结直肠疾病电子杂志 ›› 2018, Vol. 07 ›› Issue (04) : 337 -341. doi: 10.3877/cma.j.issn.2095-3224.2018.04.006

所属专题: 文献

论著

经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后肛门功能的比较
马全民1, 申占龙1,(), 刘凡1, 高志冬1, 丁超1, 尹慕军1, 谢启伟1, 姜可伟1, 叶颖江1, 王杉1   
  1. 1. 100044 北京大学人民医院胃肠外科,北京大学外科肿瘤研究室,北京市结直肠癌诊疗研究重点实验室
  • 收稿日期:2018-05-10 出版日期:2018-08-25
  • 通信作者: 申占龙
  • 基金资助:
    国家自然科学基金面上项目资助(No.81672375)

Comparison of anal function between transanal total mesorectal excision and laparoscopic total mesorectal excision

Quanmin Ma1, Zhanlong Shen1,(), Fan Liu1, Zhidong Gao1, Chao Ding1, Mujun Yin1, Qiwei Xie1, Kewei Jiang1, Yingjiang Ye1, Shan Wang1   

  1. 1. Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People′s Hospital, Peking 100044, China
  • Received:2018-05-10 Published:2018-08-25
  • Corresponding author: Zhanlong Shen
  • About author:
    Corresponding author: Shen Zhanlong, Email:
引用本文:

马全民, 申占龙, 刘凡, 高志冬, 丁超, 尹慕军, 谢启伟, 姜可伟, 叶颖江, 王杉. 经肛全直肠系膜切除与腹腔镜全直肠系膜切除术后肛门功能的比较[J/OL]. 中华结直肠疾病电子杂志, 2018, 07(04): 337-341.

Quanmin Ma, Zhanlong Shen, Fan Liu, Zhidong Gao, Chao Ding, Mujun Yin, Qiwei Xie, Kewei Jiang, Yingjiang Ye, Shan Wang. Comparison of anal function between transanal total mesorectal excision and laparoscopic total mesorectal excision[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(04): 337-341.

目的

探索与传统腹腔镜全直肠系膜切除术(lap-TME)相比,经肛全直肠系膜切除术后(TaTME)的肛门功能情况。

方法

回顾收集2015年1月至2018年3月在北京大学人民医院胃肠外科施行的直肠癌全直肠系膜切除术患者资料40例,其中TaTME组20例,lap-TME组20例,用直肠低位前切除综合征(LARS)评分量表比较lap-TME与TaTME两组患者术后的肛门功能。

结果

TaTME组与lap-TME组相比,术中出血量、手术时间、淋巴结清扫数目、术后住院天数、远切缘和环周切缘等方面差异均无统计学意义(均P>0.05)。术后3个月内TaTME组LARS总评分和各项评分均显著高于lap-TME组(均P<0.05)。术后1个月两组患者在排气控制和稀便漏出两项问题中的得分差异存在统计学意义(均P<0.05),术后2个月、3个月两组患者在排气控制、稀便漏出与排便后1小时内再次排便三项问题差异均存在统计学意义(均P<0.05)。两组患者在排便次数和排便急迫问题上差异无统计学意义(P>0.05)。

结论

在术后早期,接受TaTME手术患者的肛门功能可能差于lap-TME患者,但随着术后时间的延长,经过适当的功能锻炼,TaTME术后肛门功能可在一定程度上得到改善。

Objective

To compare the anal function between rectal cancer patients underwent TaTME and lap-TME.

Methods

Forty cases of rectal cancer were collected retrospectively in Peking University Peoples Hospital from January 2015 to March 2018. Each group has 20 cases. Postoperative clinicopathological indicators and defecation function of patients were compared between lap-TME group and TaTME group.

Results

Between two group, there were no significant statistical difference in blood loss, operative time, lymph nodes harvested, postoperative hospital stay, distant resection margin, and circumferential resection margin (P>0.05). Within three months after surgery, the low anterior resection syndrome score of the lap-TME group was significantly lower than that of the TaTME group (P<0.05). One month after surgery, comparing between lap-TME group and TaTME group, there were significant difference in the score of exhaust control and fecal leakage (P<0.05). Two months and three months after surgery, there was significant statistical difference in the score of the questions about exhaust control, fecal leakage, defecation again after defecation within 1 hour (P<0.05). There was no significant difference in the frequency and urgency of defecation between the two groups (P>0.05).

Conclusion

Anal function of patient underwent TaTME procedure was worse than those underwent lap-TME in early period post-operation, but which might be improved in some extent as the time goes on.

表1 两组患者一般情况
表2 手术情况比较
表3 两组患者术后3个月LARS评分比较(±s
表4 两组患者术后1个月评分比较[n,(%)]
表5 两组患者术后第2个月评分比较[n,(%)]
表6 两组患者术后第3个月评分比较[n,(%)]
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