与全直肠系膜切除术相比，溃疡性结肠炎的直肠系膜内切除术对肠道和性功能有何影响？
Does intramesorectal excision for ulcerative colitis impact bowel and sexual function when compared with total mesorectal excision?
作者信息
Hicks Caitlin W, Hodin Richard A, Savitt Lieba, Bordeianou Liliana
机构信息
Department of Surgery, Massachusetts General Hospital Crohn's and Colitis Center, Boston, MA, USA; Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Surgery, Massachusetts General Hospital Crohn's and Colitis Center, Boston, MA, USA.
出版信息
Am J Surg. 2014 Oct;208(4):499-504.e4. doi: 10.1016/j.amjsurg.2014.05.012. Epub 2014 Jul 24.
BACKGROUND
Proctectomy for ulcerative colitis (UC) can be performed via intramesorectal (IME) or total mesorectal excision (TME).
METHODS
We compared patient-reported bowel and sexual function among IME versus TME UC patients (September 2000 to March 2011) using the Memorial Sloan-Kettering Cancer Center Bowel Function scale, Fecal Incontinence Quality of Life, Fecal Incontinence Severity Index, Female Sexual Function Instrument, and International Index of Erectile Dysfunction surveys.
RESULTS
Eighty-nine IME versus TME patients (35 ± 2 years, 57% male, 62% IME) had similar baseline characteristics, although IME patients had more open procedures (P ≤ .03). IME patients reported better fecal continence (P = .009) but similar fecal incontinence-related quality of life (P ≥ .44). For sexual function, there were no differences for either women (Female Sexual Function Instrument; P ≥ .20) or men (International Index of Erectile Dysfunction; P ≥ .22).
CONCLUSIONS
IME appears to be associated with better fecal continence but no difference in overall bowel or sexual function compared with TME in patients with UC.
背景
溃疡性结肠炎（UC）的直肠切除术可通过直肠系膜内（IME）或全直肠系膜切除术（TME）进行。
方法
我们使用纪念斯隆凯特琳癌症中心肠道功能量表、大便失禁生活质量量表、大便失禁严重程度指数、女性性功能量表和国际勃起功能障碍指数调查，比较了IME组与TME组UC患者（2000年9月至2011年3月）患者报告的肠道和性功能情况。
结果
89例IME组与TME组患者（35±2岁，57%为男性，62%为IME组）具有相似的基线特征，尽管IME组患者接受开放性手术的比例更高（P≤0.03）。IME组患者报告的大便失禁情况更好（P = 0.009），但与大便失禁相关的生活质量相似（P≥0.44）。在性功能方面，女性（女性性功能量表；P≥0.20）和男性（国际勃起功能障碍指数；P≥0.22）均无差异。
结论
与TME相比，IME似乎与更好的大便失禁情况相关，但在UC患者的整体肠道或性功能方面无差异。
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