肛门外括约肌及耻骨直肠肌注射肉毒素预防中低位直肠癌吻合口瘘的效果  

Efficacy of injection of botulinum toxin in the external anal sphincter and puborectalis to prevent anastomotic fistula in middle and low rectal cancer

作　　者：李国宾[1] 王贵宪[1] 宋军民[1] 张志永[1] 李震[1] 刘金波[1] 袁维堂[1] LI Guobin;WANG Guixian;SONG Junmin;ZHANG Zhiyong;LI Zhen;LIU Jinbo;YUAN Weitang(Department of Colorectal and Anal Surgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科

出　　处：《郑州大学学报（医学版）》2020年第1期17-21,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省基础与前沿技术研究计划项目(142300410241)

摘　　要：目的:评估肛门外括约肌及耻骨直肠肌注射肉毒素预防中低位直肠癌吻合口瘘的效果。方法:200例中低位直肠癌患者按照TME原则行腹腔镜直肠癌根治术,按预防吻合口瘘处理方法分成肉毒素组(93例),肛管组(56例),对照组(51例)。肉毒素组于术前第3天行肛门外括约肌及耻骨直肠肌肉毒素注射,肛管组于直肠吻合口上方5 cm处置管,对照组未行肉毒素注射、不放置肛管,3组其他措施如术前充分肠道准备、吻合器吻合后行手工缝合加固等操作相同。结果:3组引流管拔除时间、术后进食时间、首次排气时间、住院时间、术中出血量差异均无统计学意义(P>0.05)。3组术前第3天直肠腔内压力差异无统计学意义(P>0.05);术后第3、10天肉毒素组直肠腔内压力逐渐降低,肛管组和对照组较术前升高(P<0.05)。3组腹腔感染、呼吸道感染、肠梗阻等并发症发生率差异无统计学意义(P>0.05)。肉毒素组吻合口瘘发生率1.1%,肛管组8.9%,对照组9.8%,肉毒素组低于肛管组和对照组(P<0.05)。结论:肛门外括约肌及耻骨直肠肌注射肉毒素能够有效降低中低位直肠癌患者术后直肠肠腔内压力,从而减少吻合口瘘的发生。Aim:To evaluate the efficacy of injection of botulinum toxin in the external anal sphincter and puborectalis to prevent anastomotic fistula in middle and low rectal cancer.Methods:Out of 200 patients with middle and low rectal cancer who underwent laparoscopic radical resection according to TME principle,93 cases(botulinum toxin group)were injected botulinum toxin in the external anal sphincter and puborectalis 3 days before surgery,56 cases(anal canal group)were placed the anal canal,and 51 cases(control group)were given no botulinum toxin injection or anal canal.The other measures,such as adequate preoperative bowel preparation and anastomotic treatment were the same in all groups.Results:There were no significant differences in drainage time,postoperative feeding time,transanal exhaust time,hospital stay,intraoperative blood loss,as well as the intrarectal pressure on the 3rd day before operation among the three groups(P>0.05).Compared with those before operation,the intrarectal pressure on the 3rd,10th day after operation in the botulinum toxin group were lower,while were higher in the anal canal group and the control group(P<0.05).The incidence of complications such as abdominal infection,respiratory infection and intestinal obstruction in the three groups had no significant differences(P>0.05).The incidence of anastomotic fistula in the botulinum toxin group was 1.1%,which was significantly lower than 8.9%in the anal canal group and 9.8%in the control group(P<0.05).Conclusion:Botulinum toxin injection into external anal sphincter and puborectalis can effectively reduce the intrarectal pressure after operation in middle and low rectal cancer patients,thus may reduce the occurrence of anastomotic fistula.

关 键 词：肉毒素 全直肠系膜切除术 中低位直肠癌 吻合口瘘 

分 类 号：R735.3[医药卫生—肿瘤]