Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
Coloproctology Unit, General and Digestive Surgery, Hospital Univeristari Parc Tauli, Sabadell, Barcelona, Spain.
Int J Surg. 2015 Jan;13:142-147. doi: 10.1016/j.ijsu.2014.11.021. Epub 2014 Dec 6.
To evaluate the impact of Transanal Endoscopic Microsurgery (TEM) on anorectal function, using clinical and manometric assessments. To identify subgroups likely to develop incontinence after TEM, by stratifying the sample.
Descriptive, prospective study. Between December 2004 and May 2011, 222 patients were operated on at our hospital, of whom 21 were excluded from the study. Patients underwent anal manometry and answered a clinical incontinence questionnaire (the Wexner scale) prior to surgery, one month post-surgery, and then at four months post-surgery.
There were no statistically significant differences between preoperative Wexner questionnaire scores and values at one month and four months post-surgery. Preoperative baseline pressure (BP) values were 64 mmHg±26.18, falling to 44.26 mmHg±20.11 at one month and to 48.86 mmHg±21.14 at four months. Voluntary Contraction Pressure (VCP) reached preoperative values of 200.49 mmHg±88.85, falling to 169.5 mmHg±84.95 and to 173.6±79 at four months. The differences in BP and VCP were statistically significant. The sample was stratified in order to identify subsets susceptible to incontinence after surgery, but no at-risk subgroups were found. Multivariate analysis did not detect any predictors of incontinence.
The sustained, controlled anal dilatation produced with TEM caused statistically significant decreases in VCP and BP one month and four months after surgery. However, the Wexner questionnaire scores did not show any association with clinical incontinence. No predictors of postoperative incontinence were observed. We conclude that TEM is a safe technique and does not affect continence.
通过临床和测压评估，评估经肛门内镜微创手术（TEM）对肛肠功能的影响。通过分层样本，确定手术后可能发生失禁的亚组。
描述性、前瞻性研究。2004 年 12 月至 2011 年 5 月期间，我们医院对 222 例患者进行了手术，其中 21 例患者被排除在研究之外。患者在术前、术后 1 个月和术后 4 个月进行肛门测压和临床失禁问卷（Wexner 量表）调查。
术前 Wexner 问卷评分与术后 1 个月和 4 个月的评分之间无统计学差异。术前基础压（BP）值为 64mmHg±26.18mmHg，术后 1 个月降至 44.26mmHg±20.11mmHg，术后 4 个月降至 48.86mmHg±21.14mmHg。自愿收缩压（VCP）达到术前的 200.49mmHg±88.85mmHg，术后 1 个月降至 169.5mmHg±84.95mmHg，术后 4 个月降至 173.6mmHg±79mmHg。BP 和 VCP 的差异有统计学意义。为了确定手术后易发生失禁的亚组，对样本进行了分层，但未发现易发生失禁的亚组。多变量分析未发现失禁的预测因素。
TEM 持续、可控的肛门扩张导致术后 1 个月和 4 个月 VCP 和 BP 有统计学显著降低。然而，Wexner 问卷评分与临床失禁无关。未观察到术后失禁的预测因素。我们得出结论，TEM 是一种安全的技术，不会影响控便能力。
