Comparison of Functional Results between Lower Third Rectal Cancer Patients Underwent Trans-anal Total Mesorectal Excision (TaTME) Associated with Inter-sphincter Resection and Patients Had Laparoscopic Inter-sphincter Resection (ISR)-A Pilot Study

低位直腸癌患者接受經肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術者與接受腹腔鏡肛門括約肌間切除術者之間功能性結果之比較

陳建信(Chien-Hsin Chen) ； 林恩光(En-Kwang Lin) ； 盧延榕(Yen-Jung Lu)

《中華民國大腸直腸外科醫學會雜誌》 30卷4期 (2019/12) Pp. 142-147

https://doi.org/10.6312/SCRSTW.201912_30(4).10807

摘要

Purpose. To investigate the differences of functional results between low rectal cancer patients underwent TaTME + ISR and Laparoscopic ISR. Patients and Methods. From January 2011 to June 2019, 29 patients with low rectal cancer who underwent neo-adjuvant concurrent chemo-radiotherapy, followed by TaTME + ISR or laparoscopic ISR in Taipei Wan-fang Hospital, were enrolled into our study. 13 patients had TaTME + ISR, as the TaATME + ISR group and 16 patients underwent laparoscopic ISR, as the control group. We used Kirwan grade, and Wexer incontinence score to evaluate the anal function of the rectal cancer patients, three months after their stoma was closed. Results. There were no differences in age, gender, bowel movements per 24 hours, and the rate of anti-diarrhea drugs use between the two groups. There were also no differences in Wexer score and Kirwan grade between TaTME + ISR and laparoscopic ISR group. But, we found that there were better results of Kirwan grade in TaTME + ISR group. It seems a better trend about anal function in TaTME + ISR group (p = 0.10). Conclusions. TaTME + ISR may be a sphincter-saving procedure with acceptable functional results in patients with low-lying rectal cancers. There was no difference between TaTME + ISR group and laparoscopic ISR group in functional results. But, there was a better trend towards the TaTME + ISR group in Kirwan grade.

關鍵字

Low rectal cancer ； Trans-anal endoscopic total meso-rectal excision (TaTME) ； Laparoscopic inter-sphincteric resection (ISR) ； Stool incontinence

並列摘要

目的：探討低位直腸癌患者接受經肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術與接受腹腔鏡肛門括約肌間切除術之間肛門功能性的差異。方法：我們回顧萬芳醫院西元2011年1月至2018年07月期間的病歷記錄，共有29位病患符合研究條件。其中有13位接受經肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術，有16位接受腹腔鏡肛門括約肌間切除術。我們使用Kirwan氏分級及Wexer氏肛門失禁指數來評估兩者間在造口關閉三個月後的肛門功能。結果：兩者之間在年齡、性別、24小時大便次數、使用抗腹瀉藥物之比例，無明顯差異。在Wexer氏肛門失禁指數及Kirwan氏分級檢定上，兩者亦無明顯差異。但是接受經肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術這組病患，似乎在Kirwan氏分級上有較佳的表現（p = 0.10），但未達統計學上明顯差異。結論：對於低位直腸癌患者而言，經肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術是一個安全可保留肛門的手術治療方式，術後有可接受的肛門功能。在患者接受肛門內視鏡全直腸繫膜切除術合併肛門括約肌間切除術與接受腹腔鏡肛門括約肌間切除術者之間，在功能上無差異。不過前者似乎在Kirwan氏分級上有較佳之傾向。

並列關鍵字

低位直腸癌 ； 經肛門內視鏡全直腸繫膜切除術 ； 腹腔鏡肛門括約肌間切除術 ； 大便失禁

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