探讨腹腔镜低位直肠癌适形保肛术（CSPO）的技术难度影响因素。

回顾性队列研究，选取2022年1月至2025年6月行腹腔镜CSPO的低位直肠癌患者62例。收集患者临床资料和术中参数，以手术时间、术中出血量作为技术难度量化指标，通过单因素分析及多因素线性回归模型筛选影响因素。用SPSS 26.0软件进行数据分析，符合正态分布的计量资料以（均数±标准差）表示，非正态分布的计量资料以[中位数（四分位数间距）]表示，计数资料以[例（%）]表示。组间比较采用独立样本t检验、Mann-Whitney U检验以及χ²检验。P<0.05为差异有统计学意义。

患者手术时间为100~280 min，中位时间185 min；术中失血量为20~350 ml，中位失血量85 ml。手术时间衡量手术难度时：肿瘤距肛缘距离、cTNM分期、新辅助放化疗史、骨盆狭窄指数均与手术时间相关（均P<0.05）；多因素线性回归显示，肿瘤距肛缘距离、骨盆狭窄指数与cTNM分期均与手术时间密切相关（均P<0.05）。术中出血量衡量手术难度时：BMI、肿瘤距肛缘距离、cTNM分期、骨盆狭窄指数均与术中出血量相关（均P<0.05）；多因素线性回归显示，肿瘤距肛缘距离、骨盆狭窄指数与cTNM分期均与术中出血量密切相关。

腹腔镜CSPO技术难度受解剖及病理因素共同影响。肿瘤距肛缘距离、骨盆狭窄指数及cTNM分期与手术时间及术中出血量密切相关，可作为评估手术难度的核心指标。

To explore the influencing factors of technical difficulty in laparoscopic conformal sphincter-preserving operation (CSPO) for low rectal cancer.

A retrospective cohort study was conducted. A total of 62 patients with low rectal cancer who underwent laparoscopic CSPO between January 2022 and June 2025 were enrolled. Clinical data and intraoperative parameters of all patients were collected. Operative duration and intraoperative blood loss were adopted as quantitative indicators of technical difficulty. Univariate analysis and multivariate linear regression models were used to screen independent influencing factors. Statistical analyses were performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as mean (

The operative duration of all patients ranged from 100 to 280 minutes, with a median of 185 minutes; intraoperative blood loss varied from 20 to 350 ml, with a median of 85 ml. When operative duration was used to reflect surgical difficulty: tumor distance from the anal verge, clinical TNM (cTNM) stage, history of neoadjuvant chemoradiotherapy, and pelvic stenosis index were all correlated with operative duration (all P<0.05). Multivariate linear regression analysis demonstrated that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were closely associated with operative duration (all P<0.05). When intraoperative blood loss was used to evaluate surgical difficulty: body mass index (BMI), tumor distance from the anal verge, cTNM stage and pelvic stenosis index were all correlated with intraoperative blood loss (all P<0.05). Multivariate linear regression further verified that tumor distance from the anal verge, pelvic stenosis index and cTNM stage were independent factors closely related to intraoperative blood loss.

The technical difficulty of laparoscopic CSPO is jointly affected by anatomical and pathological factors. Tumor distance from the anal verge, pelvic stenosis index and cTNM stage are strongly correlated with operative duration and intraoperative blood loss, and can serve as core indicators for the preoperative assessment of surgical difficulty.