[Application of ultrasound-guided perianal sphincter injection of botulinum toxin A in sphincter-preserving surgery for male ultra-low rectal cancer under 3D laparoscopy].

内容摘要

Objective: To investigate the safety and preliminary efficacy of ultrasound-guided perianal sphincter injection of botulinum toxin type A (BTX-A) in sphincter-preserving surgery in male patients with ultra-low rectal cancer. Methods: A descriptive case series study was conducted. The clinical data of 25 consecutive male patients with ultra-low rectal cancer who underwent sphincter-preserving surgery with a preoperative botulinum toxin type A (BTX-A) injection strategy in the Department of Gastrointestinal Surgery, Henan Provincial People's Hospital from January 2022 to January 2024 were retrospectively analyzed. All patients presented with a difficult pelvis or a tight anal sphincter identified by preoperative digital rectal examination. Patients received an ultrasound-guided injection of 100 U of BTX-A into the external anal sphincter 1 month preoperatively. The main outcome measures included the surgical success rate, perioperative parameters (operative time, intraoperative blood loss, and length of hospital stay), the rate of prophylactic stoma, postoperative complications, and the Low Anterior Resection Syndrome (LARS) score at 6 months postoperatively. Results: All 25 patients successfully underwent 3D laparoscopic sphincter-preserving surgery without conversion to open surgery or perioperative mortality. The mean operative time was (235.2±48.4) minutes, and the mean intraoperative blood loss was (80.4±35.9) ml. The mean postoperative hospital stay was (13.7±4.9) days. Only 2 patients (8%) underwent prophylactic stoma creation. The postoperative complication rate was 12% (3/25), including 1 case (4%) of anastomotic leakage, 1 case (4%) of perianal infection, and 1 case (4%) of urinary retention. All patients achieved recovery and were discharged from the hospital subsequent to undergoing symptomatic conservative treatment. No patient developed distal rectal ischemia/necrosis or anastomotic stenosis. At 6 months postoperatively, the mean LARS score was (21.7±6.1), and the incidence of major LARS was 12% (3/25). Conclusions: For male patients with ultra-low rectal cancer presenting with a difficult pelvis or a tight anal sphincter, preoperative ultrasound-guided injection of BTX-A into the anal sphincter is a safe and feasible novel technique. 目的： 探讨超声引导下肛周括约肌注射A型肉毒素（BTX-A）在男性超低位直肠癌保肛手术中的应用安全性及初步疗效。 方法： 本文采用描述性病例系列研究方法，回顾性分析2022年1月至2024年1月，河南省人民医院胃肠外科连续收治的25例应用术前BTX-A注射策略的男性超低位直肠癌保肛手术患者的临床资料。所有患者均为困难骨盆或术前指诊肛门过紧者。患者于术前1个月在超声引导下向肛门外括约肌注射BTX-A 100 U。主要观察指标包括手术成功率、围手术期指标（手术时间、出血量、住院时间）、预防性造口率、术后并发症及术后6个月的低位前切除综合征（LARS）评分。 结果： 25例患者均顺利完成3D腹腔镜下保肛手术，无中转开腹及围手术期死亡。全组手术时间为（235.2±48.4）min，术中出血量为（80.4±35.9）ml。术后住院时间为（13.7±4.9）d。仅2例（8%）患者接受了预防性造口。术后并发症发生率为12%（3/25），其中吻合口漏1例（4%），肛周感染1例（4%），尿潴留1例（4%），均经对症保守治疗后痊愈出院。无一例患者出现远端直肠缺血坏死或吻合口狭窄。患者术后6个月LARS评分为（21.7±6.1）分，其中重度LARS发生率为12%（3/25）。 结论： 对于存在困难骨盆或肛门过紧的男性超低位直肠癌患者，术前应用超声引导下括约肌注射BTX-A是一种安全、可行的新技术。.