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

doi:10.19401/j.cnki.1007-3639.2025.04.005

摘要/Abstract

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（P=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（P=0.007，P=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。

关键词: 经肛门全直肠系膜切除术, 直肠癌, 生活质量, 器官功能, 心理健康

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 equivalent overall quality of life between the two groups; however, the TaTME group reported significantly more severe insomnia (P=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 (P=0.007, P=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.

Key words: Transanal total mesorectal excision, Rectal cancer, Quality of life, Organ function, Psychological health

陈佳钰, 李玥, 陈帆, 李玉雪, 封士冬, 黄琦, 李大卫, 廖芝伟. 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.

CHEN Jiayu, LI Yue, CHEN Fan, LI Yuxue, FENG Shidong, HUANG Qi, LI Dawei, LIAO Zhiwei. 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.

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Variable	TaTME (n=39)	LaTME (n=38)	P value
Age/year	60.0±11.9	58.9±11.7	0.682
Gender			0.023
Male	26 (66.7%)	15 (39.5%)
Female	13 (33.3%)	23 (60.5%)
BMI/(kg·m^-2)	24.6±3.5	23.7±3.8	0.293
ASA			0.352
Ⅰ	3 (7.7%)	10 (26.3%)
Ⅱ	36 (92.3%)	24 (63.2%)
Ⅲ	0 (0.0%)	4 (10.5%)
Neoadjuvant chemoradiotherapy			0.135
No	24 (61.5%)	30 (78.9%)
Yes	15 (38.5%)	8 (21.1%)
Preoperative T stage			0.944
T1	0 (0.0%)	4 (10.5%)
T2	18 (46.2%)	12 (31.6%)
T3	21 (53.8%)	22 (57.9%)
Preoperative N stage			0.802
Negative	27 (69.2%)	28 (73.7%)
Positive	12 (30.8%)	10 (26.3%)
Positive circumferential resection margin			1.000
No	39 (100.0%)	38 (100.0%)
Yes	0 (0.0%)	0 (0.0%)
Completeness mesorectum			0.115
Complete	39 (100.0%)	35 (92.1%)
Nearly complete	0 (0.0%)	3 (7.9%)
Diverting ileostomy			0.013
No	8 (20.5%)	18 (47.4%)
Yes	31 (79.5%)	20 (52.6%)
Operative time t/min	177.2±66.2	141.5±41.9	0.006
Blood loss volume V/mL	88.5±59.2	68.4±40.2	0.087

Variable	TaTME (n=39)	LaTME (n=38)	P value
Global health status scale score	74.4 (50-100)	78.1 (50-100)	0.311
Functional scale score
Physical functioning	90.7 (33.3-100)	92.6 (53.3-100)	0.970
Role functioning	79.5 (33.3-100)	86.8 (66.7-100)	0.116
Emotional functioning	88.3 (66.7-100)	91.2 (66.7-100)	0.645
Cognitive functioning	88.5 (66.7-100)	91.2 (66.7-100)	0.210
Social functioning	72.6 (33.3-100)	79.3 (33.3-100)	0.128
Symptom scale score
Fatigue	15.6 (0-66.7)	16.3 (0-43.3)	0.775
Nausea and vomiting	3.8 (0-16.7)	10.5 (0-33.3)	0.063
Pain	9.0 (0-33.3)	4.4 (0-33.3)	0.116
Dyspnea	5.1 (0-33.3)	7.0 (0-33.3)	0.522
Insomnia	15.4 (0-66.7)	5.3 (0-33.3)	0.020
Appetite loss	25.6 (0-33.3)	35.1 (0-100)	0.833
Constipation	23.1 (0-66.7)	22.8 (0-66.7)	0.947
Diarrhea	23.1 (0-66.7)	24.6 (0-66.7)	0.868
Financial difficulties	17.9 (0-100)	10.5 (0-33.3)	0.707

Variable	TaTME (n=32)	LaTME (n=36)	P value
LARS score	21.6 ± 8.8	25.5 ± 10.0	0.094
LARS score category			0.100
No (0-20 points)	7 (21.9%)	12 (33.3%)
Minor (21-29 points)	19 (59.4%)	10 (27.8%)
Major (30-42 points)	6 (18.8%)	14 (38.9%)
Incontinence for flatus			0.095
Never	3 (9.4%)	6 (16.7%)
<Once a week	16 (50%)	22 (61.1%)
≥Once a week	13 (40.6%)	8 (22.2%)
Incontinence for liquid			0.007
Never	23 (71.9%)	14 (38.9%)
<Once a week	5 (15.6%)	15 (41.7%)
≥Once a week	4 (12.5%)	7 (19.4%)
Bowel frequency			0.091
1-3 times a day	13 (40.6%)	20 (55.6%)
4-7 times a day	5 (15.6%)	4 (11.1%)
>7 times a day	2 (6.3%)	8 (22.2%)
<Once a day	12 (37.5%)	4 (11.1%)
Clustering of stools			0.004
Never	13 (40.6%)	2 (5.6%)
<Once a week	12 (37.5%)	20 (55.6%)
≥Once a week	7 (21.9%)	14 (38.9%)
Urgency			0.318
Never	11 (34.4%)	12 (33.3%)
<Once a week	18 (56.3%)	14 (38.9%)
≥Once a week	3 (9.4%)	10 (27.8%)

Variable	No LARS (n=26)	Minor/major LARS (n=42)	Univariable		Multivariable
Variable	No LARS (n=26)	Minor/major LARS (n=42)	OR (95% CI)	P value	OR (95% CI)	P value
Surgical method				0.379
LaTME	12 (46.2%)	24 (57.1%)	1
TaTME	14 (53.8%)	18 (42.9%)	0.643 (0.240-1.719)
Age			0.941 (0.893-0.991)	0.022	0.976 (0.927-1.029)	0.372
Gender				0.194
Female	10 (38.5%)	23 (54.8%)	1
Male	16 (61.5%)	19 (45.2%)	1.937 (0.715-5.248)
BMI/(kg·m^-2)				0.003		0.261
<24	20 (76.9%)	16 (38.1%)	1
≥24	6 (23.1%)	26 (61.9%)	5.417 (1.795-16.348)		2.061 (0.583-7.28)
ASA				0.901
Ⅰ	4 (15.4%)	6 (14.3%)	1
Ⅱ-Ⅲ	22 (84.6%)	36 (85.7%)	1.091 (0.277-4.301)
Neoadjuvant chemoradiotherapy				0.291
No	21 (80.8%)	29 (69.0%)	1
Yes	5 (19.2%)	13 (31.0%)	1.883 (0.582-6.093)
Preoperative T stage				0.051
T1-2	15 (57.7%)	14 (33.3%)	1
T3	11 (42.3%)	28 (66.7%)	2.727 (0.995-7.476)
Preoperative N stage				0.213
Negative	21 (80.8%)	28 (66.7%)	1
Positive	5 (19.2%)	14 (33.3%)	0.476 (0.148-1.53)
Completeness mesorectum				0.858
Complete	25 (96.2%)	40 (95.2%)	1
Nearly complete	1 (3.8%)	2 (4.8%)	1.250 (0.108-14.513)
Diverting ileostomy				0.292
No	12 (46.2%)	14 (33.3%)	1
Yes	14 (53.8%)	28 (66.7%)	1.714 (0.629-4.674)
Operative time			1.026 (1.012-1.041)	<0.001	1.021 (1.005-1.037)	0.009
Blood loss volume			1.008 (0.996-1.019)	0.184

Variable	TaTME (n=26)	LaTME (n=15)	P value
IPSS categories			0.481
Mild dysfunction (0-7 points)	20 (76.9%)	10 (66.7%)
Moderate dysfunction (8-19 points)	6 (23.1%)	5 (33.3%)
Severe dysfunction (20-35 points)	0 (0.0%)	0 (0.0%)