评估手术入路（经肛门与经腹部）对早期直肠癌肿瘤预后和生活质量的影响：一项评估R0切除率和肠功能结局的回顾性队列研究

中华养生保健 ›› 2025, Vol. 43 ›› Issue (5): 171-174.

评估手术入路（经肛门与经腹部）对早期直肠癌肿瘤预后和生活质量的影响：一项评估R0切除率和肠功能结局的回顾性队列研究

郭海龙¹, 韩宇田¹, 曲巍¹, 白雪峰¹, 吴昊², 刘晓明¹, 王钟焰^1,*

1.齐齐哈尔医学院附属第三医院肛肠科,黑龙江齐齐哈尔,161000;
2.齐齐哈尔医学院附属第三医院普外三科,黑龙江齐齐哈尔,161000

出版日期:2025-03-01 发布日期:2025-03-17
通讯作者: ^*王钟焰,E-mail：whang8077@163.com。
作者简介:郭海龙（1988—）,男,汉族,籍贯：辽宁省沈阳市,本科,主治医师,研究方向：结直肠癌的规范化手术治疗。
基金资助:
齐齐哈尔市科技计划联合引导项目（LSFGG-2024008）

To Evaluate the Effect of Surgical Approach (Transanal and Transabdominal) on the Prognosis and Quality of Life of Patients with Early Rectal Cancer: A Retrospective Cohort Study to Evaluate R0 Resection Rate and Bowel Function Outcome

GUO Hai-long¹, HAN Yu-tian¹, QU Wei¹, BAI Xue-feng¹, WU Hao², LIU Xiao-ming¹, WANG Zhong-yan^1,*

1. Department of Proctology, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar Heilongjiang 161000, China;
2. Department of General Surgery, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar Heilongjiang 161000, China

Online:2025-03-01 Published:2025-03-17

摘要/Abstract

摘要： 目的探究不同手术入路对早期直肠癌肿瘤患者预后和生活质量的影响。方法选取2021年1月—2023年6月齐齐哈尔医学院附属第三医院收治的60例直肠癌患者作为研究对象,所有患者均择期行直肠癌根治术治疗。根据手术入路不同将其分对照组（腹部入路,n=30）和观察组（肛门入路,n=30）,比较两组肿瘤完全（R0）切除率、肠功能结局和生活质量。结果观察组R0切除率显著高于对照组,差异有统计学意义（P<0.05）;手术前,两组胃肠道症状评定量表（GSRS）评分比较,差异无统计学意义（P>0.05）,手术后1周,观察组GSRS评分显著低于对照组,差异有统计学意义（P<0.05）;手术前,两组Spitzer生活质量（SQLI）评分比较,差异无统计学意义（P>0.05）,手术后2年,观察组SQLI评分显著高于对照组,差异有统计学意义（P<0.05）。结论经肛门入路的直肠癌切除手术较腹部入路更优,R0切除率更高,术后患者肠功能恢复良好,可有效提升患者生存率和生活质量。

关键词: 早期直肠癌, 肿瘤, 切除率, 肠功能

Abstract: Objective To investigate the effect of different surgical approaches on prognosis and quality of life in early stage rectal cancer tumors. Methods A retrospective analysis was performed on 60 patients with rectal cancer admitted to the Third Affiliated Hospital of Qiqihar Medical College from 2021.1 to 2023.6.All patients underwent elective radical resection of rectal cancer. According to different surgical approaches, they were divided into control group (abdominal approach, n=30) and observation group (anal approach, n=30). The complete (R0) resection rate, intestinal function outcome and quality of life were compared between the two groups. Results The R0 resection rate in the observation group was significantly higher than that in the control group (93.33% vs 73.33%) (P<0.05); there was no statistically significant difference in the Gastrointestinal Symptom Rating Scale (GSRS) scores between the two groups before surgery (P>0.05), and one week after surgery, the GSRS scores of the observation group were significantly lower than those of the control group (P<0.05); there was no statistically significant difference in the Spitzer Quality of Life Index (SQLI) scores between the two groups before surgery (P>0.05), and two years after surgery, the SQLI scores of the observation group were significantly higher than those of the control group (P<0.05). Conclusion The rectal cancer resection through the anal approach is better than the abdominal approach, and the R0 resection rate is 93.33%. The postoperative intestinal function of the patients recovered well, which can effectively improve the survival rate and quality of life of the patients.intestinal function

Key words: early rectal cancer, tumor, resectability rate, intestinal function

中图分类号:

R657.1

郭海龙, 韩宇田, 曲巍, 白雪峰, 吴昊, 刘晓明, 王钟焰. 评估手术入路（经肛门与经腹部）对早期直肠癌肿瘤预后和生活质量的影响：一项评估R0切除率和肠功能结局的回顾性队列研究[J]. 中华养生保健, 2025, 43(5): 171-174.

GUO Hai-long, HAN Yu-tian, QU Wei, BAI Xue-feng, WU Hao, LIU Xiao-ming, WANG Zhong-yan. To Evaluate the Effect of Surgical Approach (Transanal and Transabdominal) on the Prognosis and Quality of Life of Patients with Early Rectal Cancer: A Retrospective Cohort Study to Evaluate R0 Resection Rate and Bowel Function Outcome[J]. ZHONGHUA YANGSHENG BAOJIAN, 2025, 43(5): 171-174.

参考文献

[1] 罗晨,沈玲,王传伟,等.腹腔镜结直肠癌根治术后患者早期下床活动现状及影响因素[J].上海交通大学学报(医学版),2023,43(9):1201-1210.
[2] 张爱,朱宁,杨路路,等.结直肠癌中CD66b+肿瘤相关中性粒细胞和促纤维间质反应与临床病理学特征及预后的关系[J].临床与实验病理学杂志,2024,40(4):396-401.
[3] 崔伟,张玉瑾,孙亮,等.使用下腹部陈旧手术切口做直肠癌标本取出和预防性造口的可行性研究[J].中华结直肠疾病电子杂志,2020,9(4):387-390.
[4] 李小鹏,李静,王炜,等.经自然腔道取标本的腹腔镜手术与腹腔镜辅助手术在直肠癌根治术中的近期疗效比较[J].西安交通大学学报(医学版),2023,44(6):990-995.
[5] 白雪杉,林国乐,薛晓强,等.以经肛门内镜微创手术为平台经肛全直肠系膜切除术治疗中低位直肠癌的临床疗效[J].中华消化外科杂志,2021,20(3):339-345.
[6] 白雪杉,李昀昊,林国乐,等.经肛门内镜显微手术局部切除早期直肠癌后续治疗策略对临床结局影响研究[J].中国实用外科杂志,2020,40(3):346-352.
[7] 顾晓哲,杨小宝,凌珅,等.GSRS评分改良分级系统在评估结肠癌患者发生术后长期胃肠功能紊乱中的临床应用[J].国际外科学杂志,2023,50(11):756-761.
[8] 周德花,王小东,马玉花,等.胃肠息肉病人情绪障碍现状调查及其影响饮食行为和生活质量的中介效应研究[J].蚌埠医学院学报,2024,49(7):957-960,964.
[9] 牛刚,王建锋,龚瑜,等.腹腔热灌注化疗辅助治疗结直肠癌合并恶性腹腔积液的疗效及安全性[J].癌症进展,2023,21(4):442-445.
[10] 吴家剑,胡宝生,陈铁良,等.瑞芬太尼靶控输注对结直肠癌根治术患者麻醉效果及安全性的影响[J].解放军医药杂志,2022,34(7):107-111.
[11] 秦伟,胡延岩,徐玺谟,等.中低位直肠癌经肛门与腹腔镜全直肠系膜切除术后近期疗效荟萃分析[J].外科理论与实践,2022,27(5):435-442.
[12] ZHUANG C L, ZHANG F M, WANG Z, et al.Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique[J].Surg Endosc.,2021,35(1):476-485.
[13] 陈玲玲,王晶晶.Orem护理模式对内镜黏膜下剥离术直肠癌患者肠胃功能恢复及自护能力的影响[J].国际护理学杂志,2024,43(11):2004-2008.
[14] 武文龙,章帅,傅志军,等.腔镜直线切割吻合器用于T1期中低位直肠癌经肛门局部切除术的疗效及安全性[J].现代肿瘤医学,2023,31(1):121-125.
[15] 谢成,汪勇.腹部无辅助切口经肛门取标本的腹腔镜下低位直肠前切除术(CRC-NOSESⅠ式C法)对低位直肠癌患者术后控便功能及生活质量的影响[J].结直肠肛门外科,2020,26(3):332-336,341.
[16] 吴玲利. 腹腔镜下经肛拖出式直肠癌前切除术对低位直肠癌的疗效及对患者肛肠功能和生活质量的影响[J].实用癌症杂志,2021,36(10):1686-1689.
[17] 石守森,杨阳,黄珂,等.括约肌间切除术与人工肛门重建对低位直肠癌根治术患者术后生活质量的影响[J].中国现代普通外科进展,2022,25(2):128-131.