Tsarkov P, Barkhatov S, Shlyk D, Safyanov L, Balaban V, He M
Clinic of Colorectal and Minimally Invasive Surgery, Sechenov University, Moscow, Russia.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
Tech Coloproctol. 2024 Dec 19;29(1):23. doi: 10.1007/s10151-024-03071-6.
This study aimed to evaluate the risk factors associated with rectal perforation during various surgical interventions for presacral cysts.
This retrospective study included 73 participants from 2013 to 2023 who met the inclusion criteria. Participants underwent surgical treatments through transabdominal, perineal, or combined approaches. Preoperative assessments of presacral cysts were performed using computed tomography (CT) and magnetic resonance imaging (MRI). Biannual postoperative follow-ups involved ultrasound, CT, or MRI scans. Data analysis was conducted using RStudio software.
The incidence of rectal perforation did not differ significantly across surgical approaches [combined 2 (18%) vs. perineal 3 (8.8%) vs. transabdominal 4 (14%), P = 0.7]. Cyst capsule rupture was more frequent in the transabdominal and combined approaches [17 (61%) and 5 (45%), respectively] versus perineal approach [8 (24%), P = 0.011]. The laparoscopic subgroup experienced a higher rate of cyst rupture compared to the robotic subgroup, with rectum perforation cases only correlating with ruptures in the robotic subgroup. Intraoperative complications prompted conversions to open surgery in the laparoscopic group, unlike in the robotic group. Postoperative follow-up revealed no mortalities, with malignant transformation observed in two cases and local recurrences in three. While univariate analysis did not identify significant predictors of rectal wall perforation, multivariate analysis suggested that the risk of perforation increased with cyst rupture and decreased when the cyst was located further from the anal verge.
The study identifies two primary risk factors for rectal wall perforation: the cyst capsule integrity and the cyst-rectum shortest distance, with the latter being accurately determined by MRI. These findings may inform further surgical planning and risk assessment.
本研究旨在评估骶前囊肿各种手术干预过程中与直肠穿孔相关的危险因素。
这项回顾性研究纳入了2013年至2023年符合纳入标准的73名参与者。参与者通过经腹、经会阴或联合入路接受手术治疗。术前使用计算机断层扫描（CT）和磁共振成像（MRI）对骶前囊肿进行评估。术后每半年进行一次随访，包括超声、CT或MRI扫描。使用RStudio软件进行数据分析。
不同手术入路的直肠穿孔发生率无显著差异[联合入路2例（18%）、经会阴入路3例（8.8%）、经腹入路4例（14%），P = 0.7]。经腹和联合入路的囊肿包膜破裂比经会阴入路更频繁[分别为17例（61%）和5例（45%）]，而经会阴入路为8例（24%），P = 0.011。与机器人手术亚组相比，腹腔镜手术亚组的囊肿破裂率更高，直肠穿孔病例仅与机器人手术亚组的破裂相关。与机器人手术组不同，腹腔镜手术组术中并发症促使转为开放手术。术后随访未发现死亡病例，2例出现恶性转化，3例出现局部复发。单因素分析未发现直肠壁穿孔的显著预测因素，多因素分析表明，穿孔风险随囊肿破裂而增加，囊肿距肛缘越远，穿孔风险越低。
该研究确定了直肠壁穿孔的两个主要危险因素：囊肿包膜完整性和囊肿与直肠的最短距离，后者可通过MRI准确测定。这些发现可能为进一步的手术规划和风险评估提供参考。
