Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
J Surg Oncol. 2013 Sep;108(4):225-9. doi: 10.1002/jso.23379. Epub 2013 Jul 19.
The only two procedures for surgical treatment of ultra-low rectal cancer without a permanent abdominal stoma are the intersphincteric resection (ISR) and the abdominoperineal resection (APR) plus a perineal pseudocontinent colostomy (PCC). This study compared functional results and quality of life following these two techniques.
Between January 1995 and December 2011, 36 patients had undergone an ISR (n = 14) or a PPC (n = 22) for very low rectal cancer. The Cleveland Clinica Florida (Wexner) fecal incontinence questionnaire and the EORTC Quality of Life questionnaire QLQ-C30 and CR38 had been administered.
There were no differences in gender, age, the interval between surgery and questionnaire responses, preoperative TNM staging, perioperative treatment, the laparoscopic approach and circumferential margin involvement rate between the groups. The ISR and PPC led to no difference in quality of life (Qol) and continence with a median Wexner score of respectively 11 and 10 (P = 0.403) and a fecal incontinence rate of 58.2% and 41% (P = 0.221). The incontinent patients had experienced worse social functioning and tended to have worse overall health. The patients who had undergone ISR had more defecation problems and evacuation difficulties.
Qol and continence are similar between ISR and PPC.
治疗超低位直肠癌且避免永久性腹部造口的两种唯一手术方法是经肛门内外括约肌间切除术（ISR）和腹会阴联合切除术（APR）加会阴假肛结肠造口术（PCC）。本研究比较了这两种技术的功能结果和生活质量。
1995 年 1 月至 2011 年 12 月期间，有 36 名患者因极低位直肠癌接受了 ISR（n=14）或 PPC（n=22）手术。采用克利夫兰临床佛罗里达（韦克斯纳）粪便失禁问卷和 EORTC 生活质量问卷 QLQ-C30 和 CR38 进行了评估。
两组间在性别、年龄、手术与问卷回复之间的间隔、术前 TNM 分期、围手术期治疗、腹腔镜方法和环周切缘受累率方面均无差异。ISR 和 PPC 在生活质量（Qol）和控便方面没有差异，Wexner 中位数评分分别为 11 和 10（P=0.403），粪便失禁率分别为 58.2%和 41%（P=0.221）。失禁患者的社会功能更差，整体健康状况也更差。接受 ISR 手术的患者排便问题和排空困难更多。
ISR 和 PPC 的生活质量和控便情况相似。
