Steinemann Daniel C, Zerz Andreas, Germann Sara, Lamm Sebastian H
Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland.
Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland; Klinik Stephanshorn, eSwiss Medical and Surgical Center, St Gallen, Switzerland.
J Am Coll Surg. 2016 Aug;223(2):299-307. doi: 10.1016/j.jamcollsurg.2016.04.002. Epub 2016 Apr 13.
In transrectal rigid-hybrid natural orifice translumenal endoscopic sigmoidectomy (trNS), extraction-site laparotomy is avoided, which reduces postoperative pain and improves recovery time. However, current research evaluating anorectal function after trNS is limited. This study aims to evaluate clinical continence, anorectal manometry, and quality of life in patients undergoing trNS for diverticular disease.
Between November 2013 and October 2015, patients undergoing trNS for diverticular disease were prospectively included. Patients converted to laparoscopic resection with an extraction-site laparotomy before attempted transrectal access were excluded. Anorectal manometry, including measurement of resting pressure, squeeze pressure, and retention tests; and questionnaires on continence, defecation, quality of life, and cosmesis, were obtained before and at 3 and 6 months after surgery.
Twenty-five patients were enrolled in the study. Four were converted and 1 was lost to follow-up, leaving 20 patients included in the study. Mean anal resting pressure before surgery was 59.3 mmHg (95% CI, 51.81-66.79 mmHg), decreasing to 48.85 mmHg (95% CI, 43.75-53.95 mmHg) at 3 months (p = 0.015). It normalized to 53.45 mmHg (95% CI, 47.78-59.12 mmHg) at 6 months (p = 0.168). Maximum anal squeeze pressure, retention tests, and St Marks incontinence score remained unchanged during the follow-up. Gastrointestinal Quality of Life Index remained high before (124 points) and at 6 months after surgery (128.8 points; p = 0.544).
Six months after trNS, neither clinical continence nor manometric findings deteriorated. Quality of life after trNS for recurrent diverticulitis is excellent. Long-term implications of a temporary decline in resting pressure after 3 months remain unclear and warrant long-term follow-up.
在经直肠硬质混合式自然腔道内镜乙状结肠切除术（trNS）中，无需进行取标本部位的剖腹手术，这可减轻术后疼痛并缩短恢复时间。然而，目前评估trNS术后肛门直肠功能的研究有限。本研究旨在评估因憩室病接受trNS治疗的患者的临床控便能力、肛门直肠测压及生活质量。
2013年11月至2015年10月，前瞻性纳入因憩室病接受trNS治疗的患者。排除在尝试经直肠入路前转为行带取标本部位剖腹手术的腹腔镜切除术的患者。在手术前、术后3个月和6个月进行肛门直肠测压，包括静息压力、挤压压力测量及潴留试验；并获取关于控便、排便、生活质量及美容的问卷。
25例患者纳入研究。4例患者中转手术，1例失访，最终20例患者纳入研究。术前平均肛门静息压力为59.3 mmHg（95%可信区间，51.81 - 66.79 mmHg），术后3个月降至48.85 mmHg（95%可信区间，43.75 - 53.95 mmHg）（p = 0.015）。术后6个月恢复至53.45 mmHg（95%可信区间，47.78 - 59.12 mmHg）（p = 0.168）。随访期间最大肛门挤压压力、潴留试验及圣马克失禁评分无变化。胃肠道生活质量指数在术前（124分）和术后6个月（128.8分；p = 0.544）均保持较高水平。
trNS术后6个月，临床控便能力和测压结果均未恶化。复发性憩室炎行trNS术后生活质量良好。术后3个月静息压力暂时下降的长期影响尚不清楚，需要长期随访。
