Wang Xiao-Ming, Xu Yan-Yan, Yu Gang, Rong Zhen, Geng Rui-Chao, Wang Rui, Chen Long-Yi, Liu Gang
Department of Colorectal and Anal Surgery, Linzi District People's Hospital, Linzi, Shandong, P. R. China.
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, P. R. China.
Gastroenterol Rep (Oxf). 2019 Nov 26;8(1):42-49. doi: 10.1093/gastro/goz055. eCollection 2020 Feb.
Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision (h-taTME), a completely incisionless surgical procedure has not yet been developed. This study was performed to explore the efficacy of pure taTME (p-taTME) without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer.
We retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018. Relevant patient characteristics and clinical information including the surgical procedure, specimens, pathological characteristics, and patients' post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed.
Fifty-five patients who had undergone p-taTME were included in this study. They comprised 32 (58.2%) men and 23 (41.8%) women with a mean age of 65.6 ± 10.6 years and mean body mass index of 23.4 ± 3.3 kg/m. The median surgical time was 180.0 (range, 130-360) min and estimated blood loss was 25.0 (range, 15-80) mL. The commonest post-operative complication was varying degrees of faecal incontinence (56.4%). However, such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients' quality of life.
p-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer, especially in those with obesity or a narrow pelvis. However, further studies of the indications and long-term efficacy are needed to verify the suitability of this procedure.
尽管混合经肛门全直肠系膜切除术（h-taTME）已解决了腹腔镜直肠癌手术的解剖学难题，但尚未开发出完全无切口的手术方法。本研究旨在探讨无腹腔镜辅助的单纯经肛门全直肠系膜切除术（p-taTME）作为一种完全非侵入性的直肠癌手术方法的疗效。
我们回顾性评估了2015年12月至2018年4月期间接受p-taTME手术的所有直肠癌患者。分析了相关患者特征和临床信息，包括手术过程、标本、病理特征和患者术后状态，并评估了p-taTME在直肠癌患者中的可行性。
本研究纳入了55例接受p-taTME手术的患者。其中男性32例（58.2%），女性23例（41.8%），平均年龄65.6±10.6岁，平均体重指数23.4±3.3kg/m²。中位手术时间为180.0（范围130 - 360）分钟，估计失血量为25.0（范围15 - 80）毫升。最常见的术后并发症是不同程度的大便失禁（56.4%）。然而，经过盆底功能康复锻炼后，这种失禁情况有了很大改善，并未严重影响患者的生活质量。
p-taTME对于中低位直肠癌患者，尤其是肥胖或骨盆狭窄患者而言，是一种相对安全且无切口的手术方法。然而，需要进一步研究其适应证和长期疗效，以验证该手术方法的适用性。
