低位直肠癌极限保肛术后肛门动力学研究  

Study of Anal Dynamics after Limited Anal Sphincter Preservation for Low Rectal Cancers

作　　者：张春泽[1] 郑欣怡 宇永军[1] 顾程[1] 张颖[1] 张伟华[1] ZHANG Chun-ze;ZHENG Xin-yi;YU Yong-Jun(Department of Anorectal Surgery, Tianjin UnionMedical Center, Tianjin( 300121), China)

机构地区：[1]天津市人民医院肛肠科,天津300121 [2]南开大学医学院临床医学系,天津300071

出　　处：《中国中西医结合外科杂志》2018年第6期704-709,共6页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生健康委员会重点项目(2017057);天津市卫生健康委员会科研项目(2014KZ053);天津市卫生健康委员会科研项目(2017058);天津市人民医院院级重点科研项目(2016YJZD006)

摘　　要：目的:通过分析手术前后及正常值的三维高分辨率肛门直肠测压法(3D HR-ARM)中各项测量指标间的差异及相关性,研究行低位直肠癌极限保肛术后肛肠动力学变化。方法:选取经结肠镜确诊为低位直肠癌并行保肛手术治疗的患者66例,手术前后分别进行3D HR-ARM检查,获取肛管动力学指标和直肠容量及感觉指标,分别与正常值做单样本t检验以及术前、术后配对t检验,进行统计学分析。结果:直肠癌患者术前肛门最大静息压[(84.35±29.41) mmHg]、肛门最大收缩压[(205.89±77.01) mmHg]均较正常值[(69.1±1.6) mmHg、(183.3±5.5) mmHg]增大,处于痉挛状态,差异有统计学意义(P<0.05);术前初始排便阈值[(76.56±27.50) mL]、最大耐受阈值[(123.56±34.53) mL]较正常值[(98.4±3.1)mL、(150.5±3.1) mL]减小,差异有统计学意义(P<0.05);低位直肠癌极限保肛术后直肠感觉功能指标较术前及正常范围均减小,差异有统计学意义(P<0.05),肛门内外括约肌均可恢复到正常的收缩功能,但与正常值水平相比仍稍低。结论:低位直肠癌极限保肛术后部分肛肠动力学指标明显改善,但部分神经功能降低,术中应尽量避免造成肛直周围神经丛损伤。Objective To study the changes of anorectal dynamics after limiting anal preservation and to analyse the difference and correlation between the parameters of3D HR-ARM in patients with low rectal cancer before and after operation and in normal value.Methods A total of66patients with low rectal cancer diagnosed by colonoscopy were selected and underwent anus preserving surgery.Before and after operation,3D HR-ARM was performed to obtain anal canal dynamics,rectal volume and sensory index.Then the single-sample t-test and pre-operative and post-operative paired t-test were performed for statistical analysis with normal values.Results Preoperative maximum anal resting pressure[(84.35±29.41)mmHg]and maximum anal systolic pressure[(205.89±77.01)mmHg]in patients with rectal cancer was higher than normal[(69.1+1.6)mmHg and(183.3+5.5)mmHg]because of in spasticity,with statistically significant differences(P<0.05);Preoperative Initial defecation threshold[(76.56±27.50)ml]and maximum tolerance threshold[(123.56±34.53)ml]was lower than normal[(98.4±3.1)ml and(150.5±3.1)ml],with statistically significant differences(P<0.05).The index of rectal sensory function in low rectal cancer after limited anal preservation surgery was significantly lower than that before operation and within normal range,with statistically significant differences(P<0.05).Both internal and external sphincter could recover to normal contractile function,but it was still a little lower than the normal level.Conclusion The anal dynamics and sensory function after limited anal sphincter preservation for low rectal cancer are related to the severity of injury of puborectalis,sphincter and perianal nerve plexus,so it is necessary to avoid the injury of anal sphincter and perianal nerve plexus as far as possible.

关 键 词：低位直肠癌 极限保肛术 三维高分辨率肛门直肠测压法 肛管动力学 

分 类 号：R735.37[医药卫生—肿瘤]