目的: 评估联合结肠成形术的经括约肌间保肛手术(intersphincteric resection, ISR)在超低位直肠癌患者中的治疗效果。方法: 选取2021年1月至2024年12月包头医学院第一附属医院连续收治、符合纳排标准的90例直肠癌患者为研究对象,接受ISR联合结肠成形术者为观察组30例,接受传统Miles及Dixon手术的各30例患者为对照1组(M组)与对照2组(D组),比较3组患者术后远端切缘(distal resection margin, DRM)阳性情况、并发症发生率、保肛率、Wexner失禁评分和生活质量满意度mFIQL(modified fecal incontinence quality of life, mFIQL)评分等指标。结果: 3组总体显微镜检查切缘阴性(resection with microscopically negative margins, R0)切除率差异具有统计学意义(P＜0.05),M组与D组间差异有统计学意义(P＜0.05),观察组与M组和D组两两比较后差异无统计学意义(P＞0.05),提示ISR联合术式在实现R0切除方面,其效果介于传统的Miles术和Dixon术之间。观察组的保肛率为100%,高于D组的保肛率。术后3个月、6个月、9个月观察组的术后Wexner评分均值均低于D组(P＜0.05),提示肛门功能优于D组。观察组的术后mFIQL评分低于M组(P＜0.05),表明其生活质量优于后者;观察组与D组相比差异无统计学意义(P＞0.05)。术后复发情况分析显示观察组术后复发率低于D组(P＜0.05)。结论: 相较于传统手术方式,联合结肠成形术的ISR手术显示出同等程度的瘤体切除效果,以及在保肛率、术后肛门功能和生活质量方面的优势。
Objective: To evaluate the therapeutic efficacy of intersphincteric resection (ISR) combined with coloplasty in patients with ultra-low rectal cancer. Methods: A total of 90 rectal cancer patients who were continuously admitted to the First Affiliated Hospital of Baotou Medical College from January 2021 to December 2024 and met the inclusion and exclusion criteria were selected as the research objects. Thirty patients who underwent ISR combined with colonoscopy were selected as the observation group, and 30 patients who underwent traditional Miles and Dixon surgeries were selected as the control group 1 (M group) and control group 2 (D group). The positive rate of distal resection margin (DRM), incidence of complications, anal preservation rate, Wexner incontinence score and modified fecal incontinence quality of life (mFIQL) score were compared among the three groups. Results: There was significant difference in the resection rate of resection with microscopically negative margins (R0) among the three groups (P＜0.05), and there was significant difference between group M and group D (P＜0.05), while there was no significant difference between the observation group and the group M and group D (P＞0.05), suggesting that the effect of ISR combined surgery in achieving R0 resection was between the traditional Miles surgery and Dixon surgery. The anal preservation rate of the observation group was 100%, which was higher than that of the D group. The mean postoperative Wexner score of the observation group was lower than that of the D group at 3 months, 6 months and 9 months after operation (P＜0.05), suggesting that the anal function was better than that of the D group. The postoperative mFIQL score of the observation group was lower than that of the M group (P＜0.05), indicating that its quality of life was better than that of the latter, but there was no significant difference between the observation group and the D group (P＞0.05). Postoperative recurrence analysis showed that the recurrence rate of the observation group was lower than that of the D group (P＜0.05). Conclusion: Compared with traditional surgical methods, ISR surgery combined with coloplasty shows the same degree of tumor resection effect, as well as advantages in anus-preserving rate, postoperative anal function and quality of life.
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