CAJ | 학술논문

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。
목적：평고경항문내경현미수술（TEM）대환자술후항문공능화생활질량적영향。방법회고성분석2008년10월도2013년6월간재항주시제삼인민의원접수TEM수술적50례직장선류화조기직장암환자적림상자료。통과항문직장측압、경직장강내초성、항문실금엄중지수량표（FISI）급SF-36건강조사간표등방법대술후항문공능급생활질량진행평고。결과술후1월시，각항항문직장측압지표균교술전유명현하강（P＜0．05）；단재술후3월시，항관최대착축압이접근술전수평（P＞0．05）；술후6월시，항관직장평균정식압화최대내수용량이회복지술전수평（P＞0．05）；술후9월시직장용량감각역치역체술전수평（P＞0．05）。술후1、3、6화9월시，50례환자중분별유30례（60％）、18례（36％）、7례（14％）화2례（4％）환자직장항관억제반사위음성。경직장강내초성검사결과현시，술후1월화6월시，항문내괄약기적관도화후도여술전상비차이균무통계학의의（균P＞0．05）。환자술후평균FISI평분교술전현저하강（5．8분비8．5분，P＜0．05），단총체생활질량평분수술전후적차이병무통계학의의（균P＞0．05）。결론 TEM대인체항문부적해부결구영향심미，진관재술후단기내환자적항문공능회수도일정영향，단절대부분환자능재6～9월회복정상。인차，TEM시일충안전、미창이유효적술식。
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.