宫颈癌伴慢性盆腔放射病患者的肛管直肠功能分析  

Analysis of anorectal function in cervical cancer patients with chronic pelvic radiation disease

作　　者：陈勇[1] 黄雨桦 王静[2] 姚丹华[1] 王剑[1] 蔡忠良[1] 毛琦[1] 李幼生[1] 

机构地区：[1]第二军医大学金陵医院(南京军区南京总医院)解放军普通外科研究所,南京医学硕士研究生210002 [2]南京中医药大学附属第三医院肛肠科,南京210001

出　　处：《医学研究生学报》2016年第4期388-391,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81270945)

摘　　要：目的盆腔放射病(pelvic radiation disease,PRD)为放疗后盆腔内多器官、多部位损伤,患者在病变小肠切除术后存在便频、便失禁等症状。直肠在盆腔放疗中是最易受放射性损伤的部位,目前针对PRD患者肛管直肠功能的研究尚不充分。文中主要了解宫颈癌伴慢性PRD患者的肛管直肠功能,并为PRD的治疗及预后判断提供依据。方法收集2014年1月至2015年1月期间南京军区南京总医院普通外科住院患者,分别纳入需行小肠切除术的宫颈癌伴PRD患者及健康对照者。健康对照者来自门诊体检人群。在排除了高血压、糖尿病等全身性疾病及便秘、盆底失迟缓等消化系统疾病后分别入PRD组(n=20)和对照组(n=20),根据年龄进行配对。所有受试者均完成肠镜、肛门测压。根据肠镜结果评估放射性直肠黏膜损伤程度,比较2组间肛管直肠测压结果。结果研究所纳入的所有研究对象均无直肠狭窄、梗阻。PRD组的肛管静息压为(47.23±9.08)mm Hg,与对照组[(58.25±9.24)mm Hg]比较,差异有统计学意义(P<0.05);肛管最大收缩压PRD组为(75.92±30.15)mm Hg,与对照组[(146.50±18.76)mm Hg]比较,差异有统计学意义(P<0.01);肛管舒张压PRD组为(23.30±12.49)mm Hg,与对照组[(39.10±9.99)mm Hg]比较,差异有统计学意义(P<0.01);直肠排便压PRD组为(22.85±16,69)mm Hg,与对照组[(50.90±9.14)mm Hg]比较,差异有统计学意义(P<0.01);直肠最大耐受量PRD组为(112.85±51.34)m L,与对照组[(173.50±48.15)m L]比较,差异有统计学意义(P<0.01);2组在直肠初始阈值(P=0.416),直肠排便感觉阈值(P=0.161);括约肌功能长度(P=0.313)方面差异均无统计学意义。结论宫颈癌伴PRD患者因放疗致其肛门内外括约肌功能受损,直肠最大耐受容量减少。肠道手术前需评估其肛管直肠的神经与肌肉功能,以制定合适的手术方案,从而最大程度改善PRD患者术后的生活质量。Objective Pelvic radiation disease（ PRD） is multiple injuries in more than one organ resulted by pelvic radiotherapy. Patients have the symptoms of frequent feces and fecal incontinence after the resection of small bowel lesion. Sugeries on PRD patients were mainly distal ileum and ilieocecal valve resections,while the most susceptible part of pelvic radiation injury is rectum.However,little research has been done concerning PRD patients＇ anorectal functions. This study was mainly to evaluate the anorectal function of cervical cancer patients with PRD in order to provide evidence for the therapy and prognosis of PRD. Methods Cervical cancer patients with PRD in need of small bowel resection who hospitalized in our department from January 2014 to January 2015 were collected as patient group,while people from outpatient physical exam group were selected as control group according to the exclusion criteria of hypertension,diabetes,constipation and unrelaxed pelvic floor syndrome. PDR group and control group were matched according to age. All subjects underwent colonoscopy and anorectal manometry. Rectal radiation injury was estimated on the basis of colonoscopy results. Anorectal manometry results of PRD group and control group were analysised statistically. Results PRD group and control group both included 20 women without stenosis or obstruction in rectum. Significant difference was found between PRD group and control group in anal resting pressure（ 47. 23 ± 9. 08 mm Hg vs 58. 25 ± 9. 24 mm Hg,P〈 0. 05）,anal maximum squeezing pressure（ 47. 23 ± 9. 08 mm Hg vs 58. 25 ± 9. 24 mm Hg,P〈 0. 01）,anal distension pressure（ 23. 30 ± 12. 49 mm Hg vs 39. 10 ± 9. 99 mm Hg,P 〈0. 01）,rectal defecation pressure（ 22. 85 ± 16,69 mm Hg vs 50. 90 ± 9. 14 mm Hg,P〈 0. 01） and maximum tolerated rectal volume（ 112. 85 ± 51. 34 m L vs 173. 50 ± 48. 15 m L,P 〈0. 01）. There was no significant difference between the two groups as to the lenghth of functional sphincters（ P = 0. 313）,rectum in

关 键 词：盆腔放射病 放射性肠炎 放射性肠损伤 直肠肛门测压 内镜评分 

分 类 号：R574[医药卫生—消化系统]