Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Sinyi District, Taipei, 11031, Taiwan.
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Surg Endosc. 2017 Nov;31(11):4466-4471. doi: 10.1007/s00464-017-5499-8. Epub 2017 Apr 3.
Robotic intersphincteric resection (ISR) has been introduced for sphincter-preservation in the treatment of low rectal cancer. However, many patients experience anorectal symptoms and defecatory dysfunction after ISR. This study aims to evaluate the anorectal complications that develop after ISR.
The medical records of 108 patients who underwent robotic ISR at Taipei Medical University Hospital, Taipei, Taiwan between December 2011 and June 2016 were retrospectively reviewed. Photographic records of perineal conditions were documented at the following time intervals after surgery: 1 day, 2 weeks, 1, 2, 3 and 6 months. Clinical outcomes and treatment results were analysed.
Eighty-five patients (78.7%) developed edematous hemorrhoids after surgery. These subsided at a median of 56 days after operation (range 23-89 days). Forty-six patients (42.6%) were found to have anal stenosis requiring anal dilatation. Sixteen patients (14.8%) had neorectal mucosal prolapse, which was noted to occur at an average of 98 days after surgery (range 41-162 days). Multivariate analysis showed that the occurrence of edematous hemorrhoids was associated with operating time (P = 0.043), and male gender was a significant risk factor for anal stenosis (P = 0.007).
This is the first study reporting on the clinical outcomes of anorectal status after robotic ISR. Further studies are needed to assess the long-term effects of these anorectal complications.
机器人经肛门内括约肌间切除术（ISR）已被引入用于保肛治疗低位直肠癌。然而，许多患者在 ISR 后会出现肛肠症状和排便功能障碍。本研究旨在评估 ISR 后发生的肛肠并发症。
回顾性分析 2011 年 12 月至 2016 年 6 月在台北医学大学附属医院接受机器人 ISR 的 108 例患者的病历。术后以下时间间隔记录会阴情况的照片记录：术后 1 天、2 周、1、2、3 和 6 个月。分析临床结果和治疗结果。
85 例患者（78.7%）术后出现水肿性痔。这些在术后中位数 56 天（范围 23-89 天）消退。46 例患者（42.6%）发现有肛门狭窄需要肛门扩张。16 例患者（14.8%）有新直肠黏膜脱垂，平均在术后 98 天（范围 41-162 天）时发现。多变量分析显示，水肿性痔的发生与手术时间有关（P=0.043），男性是肛门狭窄的显著危险因素（P=0.007）。
这是第一项报告机器人 ISR 后肛肠状况临床结果的研究。需要进一步研究评估这些肛肠并发症的长期影响。
