探讨单孔和多孔腹腔镜辅助经肛全直肠系膜切除术（TaTME）治疗低位直肠癌对肛肠动力学及炎性因子的影响。

回顾性分析2015年4月至2017年7月深圳市龙华区人民医院收治的84例低位直肠癌患者，根据治疗方案不同分为两组，其中单孔组40例，采用单孔腹腔镜辅助TaTME治疗；多孔组44例，采用传统多孔腹腔镜辅助TaTME治疗。观察和对比两组患者的各项围手术期指标、手术前后肛肠动力学指标以及血清炎性因子的变化情况。

（1）单孔组患者的术中出血量、手术时间、淋巴结清扫数目、术后肛门排气时间、拔除引流管时间、下床活动时间以及总住院时间等围手术期指标均显著优于多孔组（P<0.05）。（2）与术前相比，两组患者术后15 d的肛管静息压（ARP）、肛管最大收缩压（MSP）、直肠最大耐受容量（MTV）、高压区长度（HPZ）均显著降低，而直肠静息压（RRP）、直肠肛管抑制反射阈值（AIRT）水平显著升高，差异均有统计学意义（P<0.05）。多孔组术后15 d的ARP、MSP、MTV、HPZ的水平显著低于单孔组（P<0.05），而RRP、AIRT水平则显著高于单孔组（P<0.05）。（3）手术前单孔组与多孔组血清炎性因子白细胞介素（IL）-6、IL-8、血清淀粉样蛋白A（SAA）、肿瘤坏死因子α（TNF-α）与C反应蛋白（CRP）等水平比较，差异无统计学意义。术后两组患者的相关血清炎性因子等水平均出现显著上升（P<0.05），其中多孔组患者的血清因子水平均显著高于单孔组患者（P<0.05）。

与传统多孔腹腔镜相比，单孔腹腔镜辅助TaTME治疗低位直肠癌对患者的肛肠动力学以及炎性因子水平的影响更小，可以明显改善手术治疗效果，值得进一步推广。

To compare the effects of single-port and multiple-port laparoscopic assisted transanal total mesorectal excision (TaTME) on the anorectal dynamics and inflammatory factors in the treatment of low rectal cancer.

A retrospective analysis of eighty-four patients with low rectal cancer admitted to the People's Hospital of Longhua District from April 2015 to July 2017 was carried out and they were divided into single-port group (40 cases, treated with single-port laparoscopic TaTME) and multiple-port group (44 cases, treated traditional porous laparoscope-assisted TaTME). The perioperative indexes, preoperative anorectal dynamic indexes and levels of serum inflammatory factors between the two groups were observed and compared.

(1) The perioperative indexes of intraoperative bleeding, operation time, number of lymph node dissection, postoperative anus exhaust time, removal of drainage tube time, bed activity time and total hospitalization time of the single-port group were significantly better than those of the multiple-port group (all P<0.05). (2) Compared with preoperative levels, the ARP, MSP, MTV and HPZ decreased significantly at 15 d after operation, and the levels of RRP and AIRT increased significantly, the differences were statistically significant between the two groups (P<0.05). The levels of ARP, MSP, MTV and HPZ in the multiple-port group at 15 d after operation were significantly lower than those in the single-port group (P<0.05), while RRP and AIRT levels were significantly higher (P<0.05). (3) There were no significant differences in serum inflammatory factors such as IL-6, IL-8, SAA, TNF-α and CRP between the two groups before operation. After operation, the levels of serum inflammatory factors in the two groups were both significantly increased (P<0.05), of which the multiple-port group was significantly higher than that in the single-port group (P<0.05).

Compared with conventional multiple-port laparoscopy, single-port laparoscopic assisted TaTME can obviously improve surgical treatment for low rectal cancer, while the influences on anorectal motility and inflammatory factor levels are smaller, and is worthy of further promotion.