新辅助放化疗对中低位直肠癌患者肛门直肠功能的影响  

Effects of neoadjuvant chemoradiotherapy on anorectal function in patients with mid and low rectal cancer

作　　者：皮艳娜[1] 肖毅[2] 王智凤[1] 刘芳宜[1] 林国乐[2] 邱辉忠[2] 方秀才[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,100730 [2]中国医学科学院北京协和医学院北京协和医院基本外科,100730

出　　处：《中华医学杂志》2014年第24期1857-1860,共4页National Medical Journal of China

基　　金：基金项目：国家高技术研究发展计划（2010AA023007）;国家科技支撑计划（2007BA104801）

摘　　要：目的 研究新辅助放化疗对中低位直肠癌患者肛门直肠功能的影响.方法 选取中国医学科学院北京协和医院2012年10月至2013年11月期间确诊为中低位直肠癌、拟行新辅助放化疗的22例患者,男14例,女8例,年龄（59±10）岁;在放化疗前和放疗结束后6周进行排便症状的评估和三维高分辨肛门直肠压力测定.结果 新辅助放化疗后,22例患者中21例的排便症状（包括排便次数增加、粪便性状异常、便血和排便急迫感等）显著改善;其中8例低位直肠癌患者在新辅助放化疗后肛门括约肌高压带长度显著增加[（3.84±0.61）比（2.96±0.80）cm,P=0.003],肛门直肠测压其他指标无明显变化（均P＞0.05）.结论 新辅助放化疗在发挥对肿瘤降期作用的同时,可显著改善中低位直肠癌患者的排便症状,增加低位直肠癌患者肛门括约肌高压带长度.Objective To evaluate the effects of neoadjuvant chemoradiotherapy on anorectal function in patients with mid and low rectal cancer.Methods A total of 22 patients with mid and low rectal cancer were enrolled into this study from October 2012 to November 2013.There were 14 males and 8 females with a mean age of（59 ± 10）years.We collected the defecation-related symptoms with questionnaire interview and evaluated the anorectal function with three-dimensional high-resolution manometry before neoadjuvant chemoradiotherapy and at 6 weeks after radiotherapy.Results The defecation-related symptoms （including increase in stool frequency,change in stool form,hematochezia and urgency,etc.） improved significantly after neoadjuvant chemoradiotherapy （n =21）.Among those with lower rectal cancer （n =8）,the length of high-pressure zone in manometry increased significantly after neoadjuvant chemoradiotherapy （（3.84 ± 0.61） vs （2.96 ± 0.80） cm,P =0.003）.However,there was no significant change for other parameters in anorectal function（all P 〉 0.05）.Conclusions In patients with mid and low rectal cancer,neoadjuvant chemoradiotherapy may improve the defecation symptoms and enhance anal sphincter high-pressure zone for lower rectal cancer.And it is probably due to its tumor-downsizing effect.

关 键 词：直肠肿瘤 抗肿瘤联合化疗方案 肛门直肠功能 肛门直肠测压 三维高分辨测压系统 

分 类 号：R735.3[医药卫生—肿瘤]