关键词: 经肛全直肠系膜切除术, 低位直肠癌, 恶性肿瘤, 改良Bacon术, 肛门功能

Abstract: Objective To compare the therapeutic outcomes of transanal total mesorectal excision (taTME) with primary anastomosis versus taTME combined with modified Bacon procedure in low rectal cancer patients.Methods From January 2021 to January 2024,123 patients with low rectal cancer were enrolled and divided into two groups:the control group (n=73) underwent taTME with primary anastomosis,while the study group (n=50) received taTME combined with modified Bacon procedure.To compare the two groups in terms of perioperative indicators,specimen outcomes,anal function,inflammatory factors,quality of life,and complications.Results No significant differences were observed in operative time,intraoperative blood loss,prophylactic stoma rate,or conversion to laparotomy (P>0.05).The length of hospital stay in the study group was (10.42±4.27) days,which was shorter than that in the control group [(12.68±4.18) days],and the difference was statistically significant (P<0.05).One month after the operation,the scores of the anal incontinence Scale (Wexner) and low anterior rectal resection syndrome (LARS) in both groups were increased compared with those before the operation,and the difference was statistically significant (P<0.05).The levels of interleukin-6,high-sensitivity C-reactive protein and interferon-γ in the study group 3 days after the operation were (49.47±8.15) pg/ml,(19.23±2.21) mg/L and (115.87±15.93) ng/L,respectively.The control groups were (54.38±7.19) pg/ml,(22.42±2.49) mg/L and (124.19 ±18.21) ng/L respectively.There was a statistically significant difference between the two groups (P<0.05).One month after the operation,the scores of emotional status,social/family status,physical status and functional status in both groups were increased compared with those before the operation,and the differences were statistically significant (P<0.05).The scores of emotional status,social/family status,physical status and functional status of the research group one month after the operation were (23.21±2.18) points,(25.49±2.41) points,(24.33±2.24) points and (24.66±2.28) points respectively.The control groups were (19.66±2.28) points,(21.33±2.25) points,(20.28±2.49) points and (20.28±2.41) points respectively.There was a statistically significant difference between the two groups (P<0.05).The incidence rates of complications in the study group and the control group were 6.00% and 19.18% respectively.There was a statistically significant difference between the two groups (P<0.05).Conclusion For low rectal cancer patients,taTME combined with modified Bacon procedure demonstrates advantages in reducing postoperative inflammation,decreasing complications,shortening recovery time,and improving quality of life compared to taTME with primary anastomosis.

Key words: transanal total mesorectal excision, low rectal cancer, malignant tumors, improved Bacon technique, anal function