Department of Colorectal Surgery, Lankenau Hospital and Institute of Medical Research, 100 Lancaster Avenue, Medical Office Building West, Suite 330, Wynnewood, PA, 19096, USA.
Surg Endosc. 2014 Jan;28(1):193-202. doi: 10.1007/s00464-013-3155-5. Epub 2013 Sep 12.
Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter's musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years.
A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment.
Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence.
Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.
经肛门内镜微创手术（TEM）是一种用于切除各种直肠病变的微创治疗方法。由于扩张肛门以允许放置 40mm 宽的内镜以及直肠的部分切除和随后的直肠容积丧失，可能导致括约肌的过度伸展，这引起了对术后肛门直肠功能的关注。关于 TEM 后患者对肛门直肠功能和生活质量满意度的数据很少。本报告介绍了在 10 年期间收集的患者满意度数据。
通过查询 1997 年至 2007 年期间接受 TEM 的患者的前瞻性维护数据库，使用粪便失禁生活质量量表问卷、欧洲癌症研究与治疗组织生活质量问卷（EORTC QLQ-C30）第 3 版问卷以及作者设计的问卷来识别接受调查的患者，以评估对生活质量的满意度。在 86 名患者中，有 57 名（66%）对问卷做出了回应。通过年龄、术前诊断、直肠肿瘤水平、切除方法和放射治疗来确定患者满意度结果。
大多数患者（94.7%）更喜欢 TEM 而不是造口术。年龄（p=0.03）和病变性质（p=0.03）是影响应对方式的唯一因素。抑郁仅受恶性肿瘤的影响（p=0.001）。切除方法是唯一显著影响整体生活方式的因素（p=0.002）。肿瘤水平（p=0.8）和放射治疗（p=0.9）均不影响 TEM 后患者对生活方式的满意度。恶性肿瘤的存在（p=0.004）和全层切除（p=0.02）与粪便失禁问题更多有关。
TEM 后对粪便控制的满意度通常较高。肿瘤水平、肿瘤大小和放射治疗均不会影响 TEM 后的满意度。年轻的年龄和良性病变有助于患者更好地应对生活方式的改变并减少抑郁。黏膜下切除的患者满意度显著更高。
