肛门外括约肌注射肉毒素在低位直肠癌改良Bacon手术中的应用  

Application of botox injection into external anal sphincter in modified Bacon operation for low rectal cancer

作　　者：张茂润 孙振强[1] 苏锦松 唐寄焱 米纪元 宋军民[1] ZHANG Maorun;SUN Zhenqiang;SU Jinsong;TANG Jiyan;MI Jiyuan;SONG Junmin(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;不详)

机构地区：[1]郑州大学第一附属医院,郑州450052

出　　处：《实用医学杂志》2022年第6期754-757,共4页The Journal of Practical Medicine

基　　金：河南省高等学校重点科研项目计划基金资助(编号:21A310019)。

摘　　要：目的 评估肛门外括约肌注射肉毒素在低位直肠癌改良Bacon手术中的应用的有效性和安全性。方法 回顾性分析2016年6月至2019年10月我院收治的符合条件的低位直肠癌患者的临床病历资料。其中行改良Bacon术合并应用肉毒素患者43例,单纯行改良Bacon术36例。比较两组患者的手术时间、术中失血量、术后首次排气时间、住院时间等手术相关情况、术后腹盆腔感染、呼吸道感染、肠梗阻、外置肠管坏死、肛门狭窄等并发症发生率以及术后LARS评分及LARS分级。结果 两组患者均顺利完成手术,无术中或术后死亡病例。两组性别、年龄、BMI、麻醉ASA评分、肿瘤直径、肿瘤距肛缘距离、肿瘤分期比较,差异无统计学意义(P> 0.05)。两组手术时间、术中失血量、术后首次排气时间、住院时间等手术相关情况比较,差异无统计学意义(P> 0.05)。两组术后腹盆腔感染、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)。两组术后LARS评分及LARS分级比较差异无统计学意义(P> 0.05)。肉毒素组外置肠管坏死、肛门狭窄发生率低于改良Bacon术组(P <0.05)。结论 对于行改良Bacon术的低位直肠癌患者,术前于肛门外括约肌注射肉毒素,能够有效降低术后脱出结肠缺血坏死和肛门狭窄的发生率,且在术中、术后并发症及肛门功能恢复上具有和常规手术方案同样的效果。Objective To evaluate the efficacy and safety of external anal sphincter injection of botulinum toxin in modified Bacon surgery for low rectal cancer.Methods Clinical medical records of eligible patients with low rectal cancer admitted to our hospital from June 2016 to October 2019 were retrospectively analyzed.Among them,43 patients underwent modified Bacon combined with botulinum toxin,and 36 patients underwent modified Bacon.The operative time,intraoperative blood loss,postoperative first exhaust time,length of hospital stay,postoperative incidence of complications such as abdominal pelvic infection,respiratory tract infection,intestinal obstruction,external intestinal necrosis,anal stenosis,and postoperative LARS score and LARS grading were compared between the two groups.Results Both groups of patients completed the operation successfully,without intraoperative or postoperative death.The differences in gender,age,BMI,anesthesia ASA score,tumor diameter,distance from tumor to anal margin and tumor stage between the two groups are meaningless(P>0.05).There were no significant differences in operative time,intraoperative blood loss,postoperative first exhaust time and hospital stay between the two groups(P>0.05).The difference in the incidence of postoperative complications such as abdominal pelvic infection,respiratory tract infection and intestinal obstruction between the two groups is meaningless(P>0.05).There was no statistical difference in LARS score and LARS grading between the two groups.The incidence of external intestinal necrosis and anal stenosis in botulinum toxin group was lower than that in modified B group(P<0.05).Conclusions For patients with low rectal cancer who will undergo modified Bacon operation,preoperative injection of botulinum toxin into the external anal sphincter can effectively reduce the incidence of postoperative colon ischemic necrosis and anal stricture,and has the same effect as conventional surgery in intraoperative and postoperative complications and anal function recovery.

关 键 词：肉毒素 低位直肠癌 改良Bacon手术 

分 类 号：R735.37[医药卫生—肿瘤]