Jia Y, Zhang B, Zhao Y, Zhuo G, Song X, Xiang J, Ding J
Postgraduate Training Base of Jinzhou Medical University, Characteristic Medical Center of PLA Rocket Force, Beijing, 100088, China.
Department of Colorectal Surgery, Characteristic Medical Center of PLA Rocket Force, Beijing, 100088, China.
Tech Coloproctol. 2025 Jun 9;29(1):130. doi: 10.1007/s10151-025-03174-8.
Functional outcomes and quality of life (QoL) of transverse coloplasty pouch (TCP) in intersphincteric resection (ISR) for ultralow rectal cancer remain poorly understood.
A prospective analysis was conducted on patients who received ISR treatment from January 2020 to May 2022. Patients were divided into TCP and straight coloanal anastomosis (SCAA) groups. Comparisons were made for low anterior resection syndrome (LARS) score, Wexner incontinence score (WIS), Kirwan's incontinence score, visual analog scale (VAS), and fecal incontinence quality of life (FIQL) questionnaire at 3, 6, and 12 months post ileostomy closure. Additionally, anorectal manometry outcomes were compared pre ileostomy closure.
A total of 75 patients were included, with 25 in the TCP group and 50 in the SCAA group. At 3, 6, 12 months post ileostomy closure, the TCP group showed significantly lower LARS (31, 30, 28; p = 0.033, 0.044, 0.019, respectively), WIS (11.04, 9.92, 7.32; p = 0.025, 0.043, 0.007, respectively), and Kirwan's incontinence scores (p = 0.044, 0.033, 0.022). Additionally, the TCP group showed higher VAS (5, 6, 7; p = 0.004, 0.006, 0.005, respectively) and FIQL summary scores (2.67, 2.79, 2.86; p = 0.001, 0.002, 0.004, respectively). Prior to ileostomy closure, the rectal first sensation and maximum tolerance volumes were significantly higher in the TCP group compared to the SCAA group (22 ml vs. 20 ml, 51.56 ml vs. 34.52 ml; p = 0.019, 0.038, respectively). There were no significant differences in postoperative complications or recurrence rates between the groups.
TCP is a safe technique, which may improve bowel function and QoL in ISR patients with low rectal cancer within 1 year.
对于超低位直肠癌行括约肌间切除术（ISR）时，横结肠成形贮袋（TCP）的功能结局和生活质量（QoL）仍了解不足。
对2020年1月至2022年5月接受ISR治疗的患者进行前瞻性分析。患者分为TCP组和结肠肛管直接吻合（SCAA）组。在回肠造口关闭后3、6和12个月，比较低位前切除综合征（LARS）评分、韦克斯纳失禁评分（WIS）、柯万失禁评分、视觉模拟量表（VAS）和大便失禁生活质量（FIQL）问卷。此外，比较回肠造口关闭前的肛肠测压结果。
共纳入75例患者，TCP组25例，SCAA组50例。在回肠造口关闭后3、6、12个月，TCP组的LARS评分（分别为31、30、28；p分别为0.033、0.044、0.019）、WIS评分（分别为11.04、9.92、7.32；p分别为0.025、0.043、0.007）和柯万失禁评分显著更低（p分别为0.044、0.033、0.022）。此外，TCP组的VAS评分更高（分别为5、6、7；p分别为0.004、0.006、0.005）和FIQL总分更高（分别为2.67、2.79、2.86；p分别为0.001、0.002、0.004）。在回肠造口关闭前，TCP组的直肠初始感觉和最大耐受容量显著高于SCAA组（22 ml对20 ml，51.56 ml对34.52 ml；p分别为0.019、0.038）。两组术后并发症或复发率无显著差异。
TCP是一种安全的技术，可在1年内改善超低位直肠癌ISR患者的肠道功能和生活质量。
