探究经肛全直肠系膜切除术与腹腔镜中低位直肠癌根治术两种微创术式治疗低位直肠癌的学习曲线分析及近期疗效。

前瞻性选取2022年1月至2025年1月149例低位直肠癌患者为研究对象，随机数字表法简单随机分为观察组（n=75，接受经肛全直肠系膜切除术）和对照组（n=74，接受腹腔镜中低位直肠癌根治术）。应用χ²检验或t检验，比较两组一般资料和学习曲线，并对比两组不同学习阶段围手术期指标、近期疗效和术后并发症发生率。

观察组学习曲线的拐点出现较靠后（第40例），而对照组学习曲线的拐点出现更早（第20例）；经肛全直肠系膜切除术学习曲线，在学习期（拐点前）上升的斜率更陡峭，手术时间超标程度更严重。而腹腔镜中低位直肠癌根治术学习曲线上升斜率更平缓。观察组平台期手术时间、拔管时间、住院时间较上升期明显短，术中出血量、术中引流量较上升期明显减少，差异有统计学意义（P<0.05）；上升期，观察组手术时间较对照组明显长，术中出血量、术中引流量明显高，差异有统计学意义（P<0.05），平台期与对照组比，观察组手术时间明显长，术中出血量、术中引流量明显低，差异有统计学意义（P<0.05）。观察组上升期首次下床活动时间、首次排气时间均较平台期明显缩短，系膜完整率平台期也明显高于上升期，平台期环周切缘阳性率、肛门功能评分较上升期明显降低，差异有统计学意义（P<0.05）。观察组吻合口漏、并发症总发生率在上升期明显高于平台期，亦明显高于同期对照组，差异有统计学意义（P<0.05）。

经肛全直肠系膜切除术的学习曲线较长且早期阶段难度较高，上升期手术时间更长且并发症风险显著增加，但平台期术中出血控制、术后恢复及肿瘤学质量均显著优于上升期，并部分优于腹腔镜术式，表明该术式在熟练掌握后具有较好的临床应用价值与安全性。

To investigate the learning curve and short-term outcomes of two minimally invasive procedures for low rectal cancer: transanal total mesorectal excision (TaTME) versus laparoscopic radical resection for middle and low rectal cancer.

A total of 149 patients with low rectal cancer were prospectively enrolled from January 2022 to January 2025. They were randomly divided into the observation group (n=75, treated with TaTME) and the control group (n=74, treated with laparoscopic radical resection for middle and low rectal cancer) using a random number table method. The χ² test or t test was used to compare baseline characteristics and learning curves between the two groups, as well as perioperative indicators, short-term outcomes, and postoperative complication rates at different learning stages.

The inflection point of the learning curve appeared later in the observation group (at the 40th case) and earlier in the control group (at the 20th case). The learning curve of TaTME showed a steeper slope during the learning phase (before the inflection point), with a more excessive increase in operative time. In contrast, the learning curve of laparoscopic radical resection rose more gently. In the observation group, operative time, extubation time, and hospital stay were significantly shorter in the plateau phase than in the ascending phase; intraoperative blood loss and intraoperative drainage volume were also significantly reduced (P<0.05). During the ascending phase, operative time was significantly longer, and intraoperative blood loss and drainage volume were significantly higher in the observation group than in the control group (P<0.05). In the plateau phase, operative time remained significantly longer in the observation group, but intraoperative blood loss and drainage volume were significantly lower than those in the control group (P<0.05).In the observation group, time to first ambulation and time to first flatus were significantly shorter in the plateau phase than in the ascending phase. The complete mesorectal excision rate was significantly higher in the plateau phase, while the positive circumferential resection margin rate and anal function score were significantly lower (P<0.05). The incidence of anastomotic leakage and overall complications in the observation group was significantly higher in the ascending phase than in the plateau phase, and also significantly higher than that in the control group at the same stage (P<0.05).

TaTME has a longer learning curve and greater technical difficulty in the early phase, with longer operative time and significantly higher complication risk during the ascending phase. However, the plateau phase is associated with significantly better intraoperative hemostasis, postoperative recovery, and oncological quality compared with the ascending phase, and is partially superior to the laparoscopic procedure. These findings indicate that TaTME has favorable clinical value and safety after proficient mastery.