超低位直肠癌行纵向部分括约肌切除术和经内外括约肌间切除术后肛门功能及生活质量比较

目的比较纵向部分括约肌切除术（PLRAs）和经内外括约肌间切除术（ISR）后直肠癌患者的肛门功能和生活质量。方法将99例超低位直肠癌患者按照手术方式的不同分为PLRAS组n=23）和ISR组（n=76）。于术后6、12及24个月，采用Saito功能问卷和Wexner评分量表评估术后的肛门功能，采用欧洲癌症研究与治疗组织开发的特为结直肠肿瘤患者而设的生活质量核心量表（EORTC-QLQ-CR29）评估术后的生活质量，并进行组间比较。结果①吻合口狭窄：与ISR组比较，在术后6个月，PLRAS组的吻合口狭窄程度较重（P〈0．001）；在术后12个月时改善并不明显，狭窄程度仍较ISR组重（P=-0．003）；在术后24个月，2组患者的吻合口狭窄程度比较差异无统计学意义（P-0．230）。②Saito功能问卷结果：术后6个月时，PLRAS组存在排便截断（P=0．016）、存在排便困难（P=0．008）及能分辨排气和排便（P〈0．001）患者的比例均较ISR组高；在术后12个月，PLRAS组能分辨排气和排便患者的比例仍较ISR组高（P=-0．017）；在术后24个月，2组间的差异均无统计学意义（P〉0．05）。③Wexner得分结果：各时点2组患者的Wexner得分比较差异均无统计学意义（P〉0．05）。④生活质量：在术后6个月，PLRAS组患者的会阴部疼痛得分（P=0．031）和性交困难得分（P=0．006）均高于ISR组，而排气失禁（P=0．003）、排便失禁（P=-0．043）和女性性功能（P=-0．023）得分均低于ISR组；在术后12个月，PLRAS组患者的排气失禁（P=0．012）和女性性功能（P=0．017）得分均低于ISR组，而性交困难（P=0．012）得分高于ISR组；在术后24个月，2组患者各项得分的差异均无统计学意义（P〉0.05）。结论PLRAS术后12个月内的肛门狭窄情况和对女性性功能的影响均较ISR术更为严重，但到术后24个月，其可达到同ISR术相似的肛门功能和生活质量。

Comparison of Anal Function and Quality of Life Between Partial Longitudinal Resection of The Anorectum andSphincter and Intersphincteric Resection for Very Low Rectal Cancer

Objective To compare anal function and quality of life between partial longitudinal resection of the anorectum and sphincter （PLRAS） and intersphincteric resection （ISR） for rectal cancer. Methods Ninety-nine cases of very low rectal cancer were classified as PLRAS group （n=23） and ISR group （n=76） according to different surgical method. Anal function was assessed by Saito function questionnaire and the Wexner scale in 6, 12, and 24 months after operation. At the same time, quality of life was assessed by European Organization for research and treatment of cancer quality of life questionnaire CR29 （EORTC-QLQ-CR29）. Results ① Anastomosis stenosis： compared with ISR group, the situation on anastomosis stenosis was worse in 6 months （P〈0. 001） and 12 months （P=-0. 003） after operation, but didn＇t significantly differed in 24 months after operation （P=-0. 230）. ②Results of the Saito function questionnaire： comparedwith ISR group, there were higher incidence on stool fragmentation （P=0. 016）, dyschesia （P=0. 008）, and feces-flatus discrimination （P〈 0. 001） in PLRAS group in 6 months after operation, and the incidence of feces-flatus discrimination was still higher in 12 months （P=-0. 017）, but there was no any significant difference in 24 months after operation （P 〉 0. 05）. ③ Results of Wexner scale： there were no statistical difference between the 2 groups at all recorded times （19〉 0. 05）. ④ Results of EORTC-QLQ-CR29 questionnaire： in 6 months after operation, the scores of flatulence （P=0. 003）, faecal incontinence （P=-0. 043）, and sexual interest in women （P=0. 023） of PLARS group were lower than ISR group but higher in buttock pain （P=0. 031） and dyspareunia （P=0. 006）. In 12 months after operation, the scores of flatulence （P=0. 012） and sexual interest in women （P=0. 017） were both lower than ISR group, but score of dyspareunia was higher （P=0. 012）. In 24 months after operation, there was no any significant difference （P〉0. 05）. Conclusions PLRAS surgery have worse situation of anastomosis stenosis and sexual function in women than ISR surgery before 12 months after operation, but have analogous effect in 24 months after operation.