直肠癌经肛内镜全直肠系膜切除术对肛门功能影响的临床研究

目的:探讨腹腔镜辅助经肛内镜全直肠系膜切除术对肛门功能的影响。方法:选取2010年5月―2014年1月期间行根治性全直肠系膜切除术的75例中低位直肠癌患者,其中23例行腔镜辅助经肛内镜手术(经肛内镜组),20例行开放手术(开放组),32例行腹腔镜手术(腹腔镜组),比较3组患者一般手术指标,分别采用Wexner和徐忠法评分法评估各组术后肛门功能。结果:与开放组及腹腔镜组比较,经肛内镜组术中出血量较少、术后肛门排气时间较早、术后住院时间较短,但手术时间延长(均P<0.05)。术后1个月,经肛内镜组Wexner评分分值、徐忠法评分优良率均低于开放组和腹腔镜组(均P<0.05),但术后3、6、12个月,3组间两种评分的差异均无统计学意义(均P>0.05)。结论:与开放及腹腔镜全直肠系膜切除比较,腹腔镜辅助经肛内镜全直肠系膜切除术后短期肛门功能恢复差,但后期无明显差别,且微创、恢复快。

Influence of transanal endoscopic total mesorectal excision on postoperative anal function in treatment of rectal cancer

Objective: To investigate the influence of laparoscopic-assisted transanal endoscopic total mesorectal excision (TME) on postoperative anal function in treatment of rectal cancer. Methods: Seventy-five patients with mid/low rectal cancer undergoing TME during May 2010 to January 2014 were selected. Of the patients, 23 cases received laparoscopic-assisted transanal endoscopic approach (transanal endoscopic group), 20 cases underwent open surgery (open surgery group) and 32 cases had laparoscopic procedure (laparoscopic group). The general surgical variables among the three groups were compared, and the function of the anus after operation of the three groups of patients was evaluated by using Wexner’s and Xu Zhongfa’s scoring system, respectively. Results: Compared with either open surgery group or laparoscopic group, the intraoperative blood loss was reduced, and time to first postoperative flatus was shortened, but the operative time was prolonged in transanal endoscopic group (all P<0.05). At one month after operation, both score by Wexner’s scoring system and good rate by Xu Zhongfa’s scoring system in transanal endoscopic group were lower than those in open surgery group or laparoscopic group (all P<0.05), but both of which showed no significant difference among the three groups at 3, 6 and 12 months after operation (all P>0.05). Conclusion: Compared with open and laparoscopic TME, the recovery of anal function after laparoscopic-assisted transanal endoscopic TME is poor for a short period of time, but has no obvious difference at a later period, and this procedure is more minimally invasive with fast postoperative recovery.