针灸联合生物反馈治疗直肠癌保肛术后排便失禁的效果  

Effect of Acupuncture and Biofeedback on Fecal Incontinence after Anus Preservation Operation for Rectal Cancer

作　　者：赵加应 殷琛庆 陈文杰 蔡元坤 周彦 林茵绿 王余民 王会鹏 柯重伟 ZHAO Jia-ying;YIN Chen-qing;CHEN Wen-jie;CAI Yuan-kun;ZHOU Yan;LIN Yin-lu;WANG Yumin;WANG Hui-peng;KE Zhong-wei(Department of General Surgery,The Fifth People's Hospital of Shanghai,Fudan University,Shanghai 200240,China;Department of Traditional Chinese Medicine,The Fifth People's Hospital of Shanghai,Fudan University,Shanghai 200240,China)

机构地区：[1]复旦大学附属上海市第五人民医院普外科,上海市200240 [2]复旦大学附属上海市第五人民医院中医科,上海市200240

出　　处：《中国康复理论与实践》2020年第6期715-724,共10页Chinese Journal of Rehabilitation Theory and Practice

基　　金：上海市综合医院中西医结合专项基金资助项目(No.ZHYY-ZXYJHZX-2-02);上海市闵行区医疗系统大学科建设专项基金资助项目(No.2017MWDXK01)。

摘　　要：目的探讨针灸联合生物反馈治疗直肠癌保肛术后排便失禁的效果。方法2016年1月1日至2018年6月30日,本院收治的直肠癌保肛根治术后患者226例,筛选出排便失禁者120例,随机分为对照组(n=40)、针灸组(n=40)和观察组(n=40)。术后1个月,三组均接受提肛锻炼,另外,针灸组接受针灸治疗,观察组接受针灸联合生物反馈治疗,共3个月。治疗前,治疗1、2、3个月分别检测各组大便失禁克利夫兰评分(CCF-FIS)、肛门直肠压力、盆底表面肌电和生活质量评分。结果治疗前,三组CCF-FIS、肛门直肠压力、盆底表面肌电和生活质量评分均无显著性差异(F<2.943,P>0.05)。治疗后,三组CCF-FIS均下降,肛门直肠压力、盆底表面肌电和生活质量评分均明显改善(F>5.235,P<0.01);不同时间点,针灸组和观察组各指标均优于对照组(P<0.05),观察组优于针灸组(P<0.05)。观察组治疗1个月疗效与肿瘤位置高低有关(χ^2=5.230,P<0.05),治疗后各时间点疗效与术中是否行盆腔自主神经保存术(χ^2>5.657,P<0.05)、术后是否增加放疗(χ^2>4.329,P<0.05)有关。治疗结束后3个月随访时,观察组复发率(8.6%)低于针灸组(35.7%)和对照组(35.0%)(χ^2>5.976,P<0.05),三组均未发生并发症。结论针灸联合生物反馈治疗可改善直肠癌保肛患者术后排便失禁症状,促进肛门功能康复。Objective To investigate the effect of acupuncture and biofeedback on the recovery of fecal incontinence after anus preservation operation for rectal cancer.Methods From January 1st,2016 to June 30th,a total of 226 patients with rectal cancer after anus preservation operation were selected.Finally,120 patients with fecal incontinence were randomly divided into control group(n=40),acupuncture group(n=40)and observation group(n=40).All the groups accepted levator ani movement.In addition,the acupuncture group received acupuncture,and the observation group received acupuncture and biofeedback,for three months.Cleveland Clinic Florida Faecal Incontinence Scores(CCF-FIS),anorectal pressure,pelvic floor surface electromyography and quality of life were measured before treatment,and one month,two months and three months after treatment.Results There was no significant difference in CCF-FIS,anorectal pressure,pelvic floor surface electromyography and quality of life among three groups before treatment(F<2.943,P>0.05).After treatment,all the above indexes improved(F>5.235,P<0.01),and were better in the acupuncture group and observation group than in the control group(P<0.05),especially in the observation group(P<0.05)at each time point.The curative effect of the observation group was related to the location of the tumor(χ^2>4.405,P<0.05)one month after treatment,and it was related to whether pelvic autonomic nerve preservation was performed during the operation(χ^2>4.706,P<0.05)and whether radiotherapy was added after the operation(χ^2>5.013,P<0.05)at each time point after treatment.At three months follow-up,the recurrence rate was lower in the observation group(8.6%)than in the acupuncture group(35.7%)and in the control group(35.0%)(χ^2>5.976,P<0.05).No complication occurred in all groups.Conclusion Acupuncture and biofeedback can improve the symptoms of defecation incontinence and promote the recovery of anal function after anus preservation operation for rectal cancer.

关 键 词：直肠癌 针灸 生物反馈 排便失禁 

分 类 号：R735.3[医药卫生—肿瘤]