直肠癌患者经肛门或腹腔镜行全直肠系膜切除术后的生活质量分析：一项回顾性队列研究

陈佳钰; 李玥; 陈帆; 李玉雪; 封士冬; 黄琦; 李大卫; 廖芝伟

doi:10.19401/j.cnki.1007-3639.2025.04.005

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直肠癌患者经肛门或腹腔镜行全直肠系膜切除术后的生活质量分析：一项回顾性队列研究

论著 | 更新时间：2025-12-31

- 直肠癌患者经肛门或腹腔镜行全直肠系膜切除术后的生活质量分析：一项回顾性队列研究
- Analysis of quality of life of rectal cancer patients after transanal total mesorectal excision and laparoscopic total mesorectal excision: a retrospective cohort study
- 中国癌症杂志 2025年35卷第4期页码：376-385
- 作者机构：
  
  1. 复旦大学附属肿瘤医院大肠外科，复旦大学上海医学院肿瘤学系，上海 200032
  2. 上海大学附属仁和医院普外科，上海 200431
- 作者简介：
  
  [ "陈佳钰（ORCID: 0009-0008-5351-0553），硕士研究生；" ]
  [ "共同第一作者：李玥（ORCID: 0000-0003-4864-6188），上海大学附属仁和医院普外科主治医师。" ]
  李大卫（ORCID: 0000-0002-5642-4000），博士，主任医师。
  廖芝伟（ORCID: 0000-0001-9600-1793），副主任医师，上海大学附属仁和医院普外科主任；
- 基金信息：
  
  上海市宝山区科学技术委员会医学卫生项目(21-E-26)
- DOI：10.19401/j.cnki.1007-3639.2025.04.005
  中图分类号：
- 收稿：2024-10-16，
  
  修回：2024-12-09，
  
  纸质出版：2025-04-30
- 稿件说明：
移动端阅览
陈佳钰, 李玥, 陈帆, 等. 直肠癌患者经肛门或腹腔镜行全直肠系膜切除术后的生活质量分析：一项回顾性队列研究[J]. 中国癌症杂志, 2025,35(4):376-385.

Jiayu CHEN, Yue LI, Fan CHEN, et al. Analysis of quality of life of rectal cancer patients after transanal total mesorectal excision and laparoscopic total mesorectal excision: a retrospective cohort study[J]. China Oncology, 2025, 35(4): 376-385.
陈佳钰, 李玥, 陈帆, 等. 直肠癌患者经肛门或腹腔镜行全直肠系膜切除术后的生活质量分析：一项回顾性队列研究[J]. 中国癌症杂志, 2025,35(4):376-385. DOI： 10.19401/j.cnki.1007-3639.2025.04.005.

Jiayu CHEN, Yue LI, Fan CHEN, et al. Analysis of quality of life of rectal cancer patients after transanal total mesorectal excision and laparoscopic total mesorectal excision: a retrospective cohort study[J]. China Oncology, 2025, 35(4): 376-385. DOI： 10.19401/j.cnki.1007-3639.2025.04.005.

摘要

背景与目的：

针对直肠癌经肛门全直肠系膜切除术（transanal total mesorectal excision，TaTME）术后患者生活质量的研究较少，缺乏循证医学证据。本研究旨在探讨与腹腔镜全直肠系膜切除术（laparoscopic total mesorectal excision，LaTME）相比，TaTME对患者术后生活质量的影响。

方法：

对2019年9月—2022年9月上海大学附属仁和医院及复旦大学附属肿瘤医院收治的行LaTME的直肠癌患者及同期行TaTME的直肠癌患者的临床及病理学资料进行对比分析，在术后1年时完成调查问卷：癌症患者生活质量量表（European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30，EORCT QLQ-C30）、低位前切除综合征（low anterior resection syndrome，LARS）评价量表、国际前列腺症状评分（International Prostate Symptom Score，IPSS）、广泛性焦虑量表（Generalized Anxiety Disorder-7，GAD-7）和抑郁自评量表（Patient Health Questionnaire-9，PHQ-9），对问卷结果进行比较分析。本研究通过上海市宝山区仁和医院伦理委员会的审查。本研究严格遵循《加强流行病学中观察性研究报告质量》（Strengthening the Reporting of Observational Studies in Epidemiology，STROBE）指南中的各项条目。

结果：

本研究纳入77例患者（TaTME组39例和LaTME组38例），两组患者在性别、年龄、肿瘤距肛缘距离、肿瘤分

期、术前新辅助治疗方案等方面差异均无统计学意义。EORCT QLQ-C30结果表明两组患者的生活质量相当，但TaTME组失眠症状更严重（

=0.020）。两组在LARS严重程度和评分之间差异无统计学意义。TaTME组在水样便失禁和大便簇集两个项目中表现出更好的功能（

=0.007，

=0.004）。此外，两组在IPSS、抑郁和焦虑程度上均具有可比性。

结论：

接受TaTME或LaTME的患者表现出相似的肛门功能、排尿功能、生活质量和心理健康结果，从术后生活质量方面而言，TaTME技术是腹腔镜手术的安全替代方案。

Abstract

Background and purpose:

There are few studies on the quality of life after transanal total mesorectal excision (TaTME) for rectal cancer

and there is a lack of evidence-based research. This study aimed to evaluate the impact of TaTME in comparison to laparoscopic total mesorectal excision (LaTME) on postoperative quality of life in patients.

Methods:

A retrospective analysis was conducted on clinical and pathological data from rectal cancer patients who underwent LaTME and TaTME between September 2019 and September 2022 at Renhe Hospital

Baoshan District

Shanghai

and Fudan University Shanghai Cancer Center. All the patients completed a set of validated questionnaires one year postoperatively

including the EORCT QLQ-C30

Low Anterior Resection Syndrome (LARS) score

International Prostate Symptom Score (IPSS)

Generalized Anxiety Disorder-7 (GAD-7)

and Patient Health Questionnaire-9 (PHQ-9). Comparative analysis of these survey results was performed.The study was approved by the Ethics Committee of Renhe Hospital

Baoshan District

Shanghai. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed for this study.

Results:

A total of 39 patients in the TaTME group and 38 patients in the LaTME group were included. There were no statistically significant differences between two groups regarding demographic variables such as gender and age

as well as clinical factors including tumor distance from the anal verge

tumor stage

and preoperative neoadjuvant treatment protocols. Analysis of EORCT QLQ-C30 results indicated equival

ent overall quality of life between the two groups; however

the TaTME group reported significantly more severe insomnia (

=0.020). No significant differences were observed in LARS severity or total scores between the groups

though the TaTME group demonstrated superior functional outcomes in terms of incontinence for liquid stools and clustering of stools (

=0.007

=0.004). Additionally

both groups exhibited comparable results in IPSS

and levels of depression and anxiety.

Conclusion:

The findings suggest that TaTME and LaTME yield similar outcomes in terms of anal and urinary function

overall quality of life

and psychological health

indicating that it is a viable and safe alternative to LaTME in terms of postoperative quality of life.

关键词

Keywords

references

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