Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Center of Abdominal Surgery, Vilnius University Hospital "Santaros Klinikos", Santariskiu Str. 2, LT-08661, Vilnius, Lithuania.
Int J Colorectal Dis. 2018 Apr;33(4):467-472. doi: 10.1007/s00384-018-2983-0. Epub 2018 Feb 22.
Transanal endoscopic microsurgery (TEM) procedure could potentially influence the development of fecal incontinence later in life. The aim of our study was to assess long-term functional outcomes after TEM and to determine possible variables related to incontinence.
Patients, enrolled in a prospectively collected TEM operation database, were interviewed using a postal questionnaire. The questionnaire consisted of EuroQol (EQ)-5D-5L quality of life questionnaire, Wexner fecal incontinence grading scale, and additional questions about other perianal operations and obstetric history for women. We divided patients into two groups: no or minor fecal incontinence (Wexner score of 2 and less) and non-minor incontinence (Wexner score of 3 or more).
One hundred thirty-two patients were included in the study. Patients' median follow-up time was 96 (12-168) months from their operation. Thirty-eight patients (28.8%) reported Wexner score of 3 or more, and they reported significantly worse quality of life in all tested life spheres. They were older at the time of the operation (63 (18-82) vs. 68 (50-89) years; p = 0.004), underwent longer operations (50 (10-140) vs. 60 (15-210) min; p = 0.017), and more often were operated for malignant lesions (17 (18.3%) vs. 14 (36.8%); p = 0.040). Older age at the time of operation was an independent risk factor in multivariate model (OR 1.057, 95% CI 1.010-1.106; p = 0.016).
Fecal incontinence after TEM is more common than thought previously, resulting in significantly impaired quality of life. Older age at the time of operation was an independent risk factor for developing significant fecal incontinence.
经肛门内镜微创手术（TEM）可能会影响患者日后的粪便失禁发展。本研究旨在评估 TEM 后的长期功能结果，并确定与失禁相关的可能变量。
纳入前瞻性 TEM 手术数据库的患者通过邮寄问卷进行了访谈。问卷包括欧洲五维健康量表（EQ-5D-5L）生活质量问卷、Wexner 粪便失禁分级量表以及关于其他肛周手术和女性产科史的附加问题。我们将患者分为两组：无或轻度粪便失禁（Wexner 评分 2 分及以下）和非轻度失禁（Wexner 评分 3 分或以上）。
本研究共纳入 132 例患者。患者术后中位随访时间为 96（12-168）个月。38 例（28.8%）患者报告 Wexner 评分≥3 分，他们在所有测试的生活领域报告的生活质量明显更差。这些患者在手术时年龄较大（63（18-82）岁 vs. 68（50-89）岁；p=0.004），手术时间较长（50（10-140）分钟 vs. 60（15-210）分钟；p=0.017），且更常因恶性病变而接受手术（17（18.3%）例 vs. 14（36.8%）例；p=0.040）。在多变量模型中，手术时的年龄是一个独立的危险因素（OR 1.057，95%CI 1.010-1.106；p=0.016）。
TEM 后粪便失禁比先前认为的更为常见，导致生活质量显著受损。手术时的年龄较大是发生显著粪便失禁的独立危险因素。
