低位直肠癌行臀大肌替代部分外括约肌与经括约肌间切除术后排便功能及生活质量的对比研究  

Control study on defection function and quality of life between using gluteus maximus to replace partly lateral sphincter and intersphincteric resection for low rectal cancer

作　　者：乔雷[1] 冯勇[1] 黄哲[1] 陈涓涓[1] 陈春生[1] 

机构地区：[1]中国医科大学附属盛京医院肛肠外科,辽宁沈阳110004

出　　处：《中国现代医学杂志》2009年第7期1031-1034,共4页China Journal of Modern Medicine

基　　金：辽宁省教育厅高等学校科学技术研究项目(No:05L484)

摘　　要：目的该研究以臀大肌替代部分外括约肌方式对部分外括约肌受累的患者进行了保留肛门括约肌的手术,并通过问卷调查及肛门直肠测压回顾性对比研究臀大肌替代部分外括约肌与经括约肌间切除术后的肛门排便功能和生活质量。方法对16例接受臀大肌替代部分外括约肌及25例接受经括约肌间切除术的患者进行术后1个月及1年的Wexner评分,术后1年的FIQL生活质量问卷以及直肠肛管向量测压。选择40～68岁无肛门直肠疾患、无排便功能障碍的正常志愿者25例为正常对照组。结果臀大肌替代部分外括约肌术后的Wexner评分在术后1个月明显高于经括约肌间切除组,经1年的适应及功能锻炼后,臀大肌组评分明显下降,但对照经括约肌间切除组仍有显著性差异;对自身生活质量满意方面,臀大肌组与经括约肌间切除组在1年以后没有显著性差异;而二者直肠肛管向量测压的结果在术后1年却仍有差异,与正常对照组差异一直有显著性。结论臀大肌替代部分外括约肌的手术方式是在经括约肌间切除术的基础上进一步拓展了低位直肠癌保留括约肌手术的适应证,尽管其有更高的大便失禁风险,但就其对生活质量的长期影响来看,臀大肌替代部分外括约肌的术式亦使部分外括约肌受累而保肛愿望强烈的患者提供了一种很好的术式选择。[Objective] We have used gluteus maximus to replace partly lateral sphincter to retain anal sphincter for some patients whose lateral sphincter have been pardy affected, then, we undertook retrospective control study on defection function and quality of life between using gluteus maximus to replace partly lateral sphincter and intersphincteric resection for low rectal cancer with the methods of questionnaire and anus-rectal manometry. [Methods] 16 patients underwent the replacing operation and 25 patients underwent the intersphineterie resection, who received evaluation with Wexner scoring systems after 1 month and 1 year of operation, FIQL questionnaire for quality of life and anus-rectal vectorial manometry after 1 year of operation. The normal controls selected 25 healthy people without anus-rectal disease and disordered defecation function aging 40-68-year-old. [Results] The Wexner scores af- ter 1 month of operation of using gluteus maximum to replace partly lateral sphincter were signifieandy higher than those of intersphincterie resection. After 1 year of adaptation and functional exercise, the scores of using gluteus maximus replacement decreased obviously, but contrasting with the intersphincterie resection group ,it still had significant differences. Another hand, two groups have no significant differences in quality of life after 1 year of operation. Moreover, the indexes of vectorial manometry still have significant differences one year later, and they both made a contrast to the operation extend the indication of retaining sphincter in low rectal cancer. Although it has higher than normal control group. [Conclusions] Basing on the intersphineteric reseetion, the replacing risk of defecation incontinence, in the aspect of long-term influenee on quality of life, the replacing operation supply a good choice for patients who havea strong desire to retain anus.

关 键 词：低位直肠癌 臀大肌 经括约肌间切除 排便功能 生活质量 

分 类 号：R657.1[医药卫生—外科学]