低位直肠癌保肛术后肛门功能多因素评价  

Multifactorial evaluation on anal function of low rectal cancer patients after anus-retained operation

作　　者：王永兵[1] 张根福[1] 罗芸葆[1] 郑君华[1] 李刚[1] 张文忠[1] 

机构地区：[1]上海市浦东新区人民医院,上海201299

出　　处：《结直肠肛门外科》2015年第3期157-162,共6页Journal of Colorectal & Anal Surgery

基　　金：上海市浦东新区卫生和计划生育委员会基金项目(PW2012A一18)

摘　　要：目的评价不同吻合位置对直肠癌保肛手术后肛门功能的影响及恢复情况。方法对74例肠镜检查确认的首发直肠癌患者,根据保肛术中吻合口位置与齿状线距离≤2cm,2~4cm,≥4cm分为I、Ⅱ、Ⅲ组,分别为23、25和26例,右半结肠切除术的27例作为对照组,平均年龄（59.5±14.2）岁、（61.6±12.5）岁、（62.8±11.4）岁和（63.8±9.8）岁,术前超声或CT分期均为T1~T3期,排除术后1年内局部复发或远处转移病例;于术前、术后3个月和12个月采用徐忠法5项10分法进行肛门功能评价,同时应用排粪造影和胶囊式直肠压力测定,测定患者直肠肛管静息压（ARP）、肛管最大收缩压（MSP）、直肠最大耐受容量（MTV）和直肠反射（RAIR）。结果手术后3个月徐忠法肛门功能评价I、Ⅱ、Ⅲ组满意率分别为9/23、13/25、19/26和对照组为25/27,相比差异均有统计学意义;术后12个月时为14/23、19/25、25/26和26/27,仅I组与其他组差异有统计学意义;术后3个月I、Ⅱ、Ⅲ组和对照组ARP分别为（17.3±3.12）mmHg、（19.6±4.71）mmHg、（28.5±4.69）mmHg和（39.3±5.38）mmHg,均较术前明显降低,而术后12个月时复测分别达到了（29.2±7.14）mmHg、（32.6±5.36）mmHg、（41.6±6.15）mmHg和（42.9±3.89）mmHg,除第I、Ⅱ组外差异无统计学意义;MSP在术后3个月时I、Ⅱ、Ⅲ和对照组分别为（115.5±19.53）mmHg、（141.5±21.78）mmHg、（143.6±20.47）mmHg和（171.4±19.51）mmHg,I、Ⅱ、Ⅲ组均显著低于术前水平,对照组也有下降但差异无统计学意义,术后12个月时提升至（63.5±28.26）mmHg、（172.6±30.14）mmHg、（177.3±27.43）mmHg,与对照组的（181.3±13.27）mmHg差异无统计学意义;术后3个月时MTV在I、Ⅱ、Ⅲ组分别为（68.3±18.62）mL、（87.5±15.81）mL和（101.5±13.28）mL,均显著低于术前水平,12个月时可达到（128.3±34.6）mL、（168.3±21.70）mL和（201.2±26.17）mL,三组均有上升但仍显著低�Objective To assess anal function and recovery of patients with rectal cancer after anus-retained operation of different anastomosis methods.Methods Senventy-four first onset patients with endoscopically diagnosed rectal cancer were divided into group I,Ⅱ and Ⅲ respectively according to the distance from stoma to the dentate line.Twenty-three cases was less than 2cm（group I）,25 cases was 2-4cm（group Ⅱ）and 26 cases was longer than 4cm（groupⅢ）.Twenty-senven patients undergoing right colon resection were served as the control group.The mean age for the four groups was 59.5±14.2years,61.6±12.5years,62.8±11.4years and 63.8±9.8years,respectively.All the patients were staged as stage I,Ⅱ and Ⅲ by ultrasound or CT and ruled out postoperative local recurrence in one year or distant metastasis.The Xu Zhongfa assessment method with 5items and 10-point scale was selected to evaluate the anal function before surgery and at the 3rd,12 th month after surgery.Meanwhile,defecography and the capsule style rectal pressure measurement were also adopted for the measurement of anorectal resting pressure,anal maximal squeeze pressure,rectal maximum tolerable volume and Recto anal inhibitory reflex.Results At the 3rd month after surgery,the satisfaction rate of the group I,Ⅱ and Ⅲ evaluated by the Xu Zhongfa assessment method was 9/23,13/25 and 19/26 respectively,which showed significant difference when compared to that of control group（25/27）.However,the satisfaction rate of four groups at the 12 th month after surgery was changed to 14/23,19/25,25/26 and 26/27 respectively,which showed statistical significance in group I.After 3month of operation,anorectal resting pressure of the four groups was 17.3±3.12 mmHg,19.6±4.71 mmHg,28.5±4.69 mmHg and 39.3±5.38 mmHg respectively,which was significantly lower than the preoperative ones.Whereas after 12 months of operation,the score climbed to 29.2±7.14 mmHg,32.6±5.36 mmHg,41.6±6.15 mmHg and 42.9±3.89 mmHg,which showed no statistical significance exce

关 键 词：直肠癌 保肛术 肛门功能评价 

分 类 号：R735.37[医药卫生—肿瘤]