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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 599 -604. doi: 10.3877/cma.j.issn.2095-3224.2021.06.006

论著

直肠癌经肛直肠全系膜切除术术后低位前切除综合征的研究
蒋春晖1, 刘晔1, 许春杰1, 周鸿1, 徐庆1, 顾磊1,()   
  1. 1. 200127 上海交通大学医学院附属仁济医院胃肠外科
  • 收稿日期:2021-04-06 出版日期:2021-12-25
  • 通信作者: 顾磊
  • 基金资助:
    国家自然科学基金面上项目(82072671)

Low anterior resection syndrome after transanal total mesorectal excision in rectal cancer

Chunhui Jiang1, Ye Liu1, Chunjie Xu1, Hong Zhou1, Qing Xu1, Lei Gu1,()   

  1. 1. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai 200127, China
  • Received:2021-04-06 Published:2021-12-25
  • Corresponding author: Lei Gu
引用本文:

蒋春晖, 刘晔, 许春杰, 周鸿, 徐庆, 顾磊. 直肠癌经肛直肠全系膜切除术术后低位前切除综合征的研究[J]. 中华结直肠疾病电子杂志, 2021, 10(06): 599-604.

Chunhui Jiang, Ye Liu, Chunjie Xu, Hong Zhou, Qing Xu, Lei Gu. Low anterior resection syndrome after transanal total mesorectal excision in rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(06): 599-604.

目的

对比taTME与传统腹腔镜(LapTME)对于术后发生LARS的影响,探究taTME手术入路是否加重LARS的发生。

方法

选取2018年1月~2019年9月期间直肠癌患者,根据手术方式分为taTME组与LapTME组。采集临床参数,围手术期Wexner评分与LARS评分评估肛门功能,术后随访12个月。对比两组间各项参数。

结果

本研究共纳入80例病例,其中LapTME组40例,taTME组40例。术后3个月,两组患者在Wexner评分差异无统计学意义(P>0.05);taTME组具有更高的LARS得分,但差异无统计学意义(P>0.05)。术后6个月和12个月时,LARS和Wexner评分差异均无统计学意义(P>0.05)。两组患者的Wexner评分和LARS评分均随时间推移得到明显改善。

结论

taTME可能在术后早期对肛门功能影响更大,而对术后中远期的肛门功能无明显影响。taTME的经肛入路操作不加重LARS的发生。

Objective

To compare the effect of taTME and LapTME on postoperative LARS, and to explore whether transanal approach aggravates the occurrence of LARS.

Methods

The patients with rectal cancer from January 2018 to September 2019 were divided into taTME group and LapTME group according to the operation methods. Clinical parameters were collected, and anal function was evaluated by Wexner score and LARS score during perioperative period. All patients were followed up for twelve months. The parameters between the two groups were compared.

Results

Eighty cases were included, including forty cases in LapTME group and forty cases in taTME group. At three months after operation, there was no significant difference in Wexner score between the two groups (P>0.05). The taTME group had higher LARS score, but there was no significant difference (P>0.05). There was no significant difference in LARS and Wexner scores at six and twelve months after operation (P>0.05). The Wexner score and LARS score of the two groups were significantly improved with time.

Conclusions

taTME may have a greater impact on anal function in the early postoperative period, but no significant effect in anal function in the middle and long term. The transanal approach does not aggravate the occurrence of LARS.

表1 Wexner 评分3
图1 LARS量化评分表4
表2 两组临床病理和手术特征[例(%)]
表3 两组LARS发生情况比较
图2 LARS的治疗方案22
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