经肛门内镜显微手术对直肠肿瘤患者术后肛门功能和生活质量影响的评估

目的：评估经肛门内镜显微手术（TEM）对患者术后肛门功能和生活质量的影响。方法回顾性分析2008年10月到2013年6月间在杭州市第三人民医院接受TEM手术的50例直肠腺瘤和早期直肠癌患者的临床资料。通过肛门直肠测压、经直肠腔内超声、肛门失禁严重指数量表（FISI）及SF-36健康调查简表等方法对术后肛门功能及生活质量进行评估。结果术后1月时，各项肛门直肠测压指标均较术前有明显下降（P＜0．05）；但在术后3月时，肛管最大窄缩压已接近术前水平（P＞0．05）；术后6月时，肛管直肠平均静息压和最大耐受容量已恢复至术前水平（P＞0．05）；术后9月时直肠容量感觉阈值亦达术前水平（P＞0．05）。术后1、3、6和9月时，50例患者中分别有30例（60％）、18例（36％）、7例（14％）和2例（4％）患者直肠肛管抑制反射为阴性。经直肠腔内超声检查结果显示，术后1月和6月时，肛门内括约肌的宽度和厚度与术前相比差异均无统计学意义（均P＞0．05）。患者术后平均FISI评分较术前显著下降（5．8分比8．5分，P＜0．05），但总体生活质量评分手术前后的差异并无统计学意义（均P＞0．05）。结论 TEM对人体肛门部的解剖结构影响甚微，尽管在术后短期内患者的肛门功能会受到一定影响，但绝大部分患者能在6～9月恢复正常。因此，TEM是一种安全、微创而有效的术式。

Evaluation of anal function and quality of life after transanal endoscopic microsurgery

Objective To evaluate the impact of transanal endoscopic microsurgery （TEM） on postoperative anal function and quality of life in patients with benign rectal tumor and early rectal cancer. Methods Clinical data of 50 patients with rectal adenoma and early rectal cancer undergoing transanal endoscopic microsurgery in our hospital from October 2008 to June 2013 were retrospectively analyzed. Anorectal manometry, endorectal ultrasonography （ERUS）, the fecal incontinence severity index （FISI）, and the physical and mental health status scores （SF-36） were used to evaluate preoperative and postoperative anorectal function and quality of life. Results Anorectal manometry indicated anal resting pressure （ARP）, maximum squeeze pressure （MSP）, rectal volume at sensory threshold （RVST）, maximun tolerable volume （MTV） decreased significantly at the first month after surgery （P〈0.05）. MSP returned to preoperative level at the 3rd month （P〉0.05）. ARP and MTV returned to normal values at the 6th month （P〉0.05）. RVST returned to normal values at the 9th month （P〉0.05）. Recto-anal inhibitory reflex （RAIR） was absent in 1 （2%） patient preoperatively and in 30 （60%）, 18 （36%）, 7 （14%）, 2 （4%） at the 1st, 3rd, 6th, 9th months after surgery respectively. ERUS showed similar width and thickness of internal sphincter at 1st and 6th month after surgery compared with preoperative measures（P〉0.05）. Six months after surgery, the mean FISI score decreased （preoperative vs postoperative：8.5 vs 5.8, P〈0.05）, suggesting an improvement in fecal continence. However, the overall quality of life did not dange significantly after surgery （P〉0.05）. Conclusions TEM has little impact on anorectal anatomic structure. Anal function may be compromised in the short-term, however the vast majority of patients recover completely after 6-9 months. TEM is a safe , effective and minimally invasive surgery.