中低位直肠癌新辅助放疗前后肛门功能的比较:单中心回顾性观察性研究  

Comparison of the anorectal function before and after neoadjuvant radiotherapy in mid-low rectal cancer: a retrospective observational study from single center

作　　者：孙振 王智凤[2] 孙曦羽[1] 徐徕[1] 张冠南[1] 陆君阳[1] 肖毅[1] Sun Zhen;Wang Zhifeng;Sun Xiyu;Xu Lai;Zhang Guannan;Lu Junyang;Xiao Yi(Division of Colorectal Surgery,Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China;Department of Gastroenterology,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院、北京协和医院基本外科结直肠专业组,北京100730 [2]中国医学科学院北京协和医学院、北京协和医院消化内科,北京100730

出　　处：《中华胃肠外科杂志》2024年第1期63-68,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：中央高水平医院临床科研业务费(2022-PUMCH-C-027);中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-A-001)。

摘　　要：目的比较中低位直肠癌患者放疗前后的肛门测压资料,探讨新辅助放疗对肛门功能的影响。方法本研究采用回顾性观察性研究方法,收集2020年6月至2023年4月期间,北京协和医院基本外科结直肠专业组直肠癌前瞻性登记数据库中具有新辅助放疗前后肛门直肠压力测定数据的中低位直肠癌患者临床资料,观察指标包括患者临床病理资料以及新辅助放疗前后患者肛门直肠压力测定结果,并使用logistic回归分析确定与肛门直肠测压指标发生显著改变的有关因素。结果对45例中低位直肠癌患者进行分析。其中男性32例(71.1%),女性13例(28.9%);年龄为(60±11)岁;体质指数(BMI)为(23.4±3.7)kg/m^(2)。肿瘤距肛缘距离为(5.4±1.5)cm,MRI T分期(mrT)3~4期患者有41例(81.1%),MRI N分期(mrN)阳性患者有40例(88.9%),肿瘤最大径中位数为3.4(2.9~4.5)cm,环周比中位数为66.0(45.5~75.0)%。新辅助放疗后患者的最大静息压有降低的趋势[(55.3±32.0)mmHg比(48.0±28.5)mmHg,t=1.930,P=0.060],但差异无统计学意义;最大缩榨压无明显变化。新辅助放疗后患者各时期感觉阈值均降低,其中感觉阈值的最大耐受量降低具有统计学意义[66.0(49.0,88.0)ml比52.0(39.0,73.5)ml,Z=-2.481,P=0.013]。logistic回归分析结果提示,mrN降期与最大静息压的降低有关(OR=6.533,95%CI:1.254~34.051,P=0.026),未发现与感觉阈值的最大耐受量降低有关的因素。结论新辅助放疗会导致直肠癌患者肛门功能损伤,使得肛门静息压降低和排便敏感性增高,此外mrN降期与最大静息压的降低有关。Objective The aim of this study was to evaluate the impact of neoadjuvant radiotherapy on anorectal function of patients with mid-low rectal cancer by means of high-resolution anorectal manometry.Methods A retrospective observational study was conducted.Information on patients with mid-low rectal cancer was collected from the prospective registry database of Rectal Cancer at Peking Union Medical College Hospital(PUMCH)from June 2020 to April 2023.Anorectal functions were detected using three-dimensional high-resolution manometry system.Logistic regression analysis was performed to identify the factors associated with the changed anorectal manometry.Results A total of 45 patients with mid-low rectal cancer were included in the study.Thirty-two(71.1%)patients were male,13(28.9%)patients were female.The mean age was 60±11 years,and the mean BMI was 23.4±3.7 kg/m^(2).The mean distance between the lower edge of the tumor and the anal verge was 5.4±1.5 cm.The median size of the tumor was 3.4(2.9-4.5)cm,and the median circumferential extent of the tumor was 66.0(45.5-75.0)%.41(81.1%)patients were MRI T3-4 and 40(88.9%)patients were MRI N positive.The resting pressure has a decreasing trend after neoadjuvant radiotherapy(55.3±32.0 mmHg vs.48.0±28.5 mmHg,t=1.930,P=0.060).There was no significant change in maximum squeezing and the length of the high-pressure zone after neoadjuvant radiotherapy.All volumes describing rectal sensitivity(first sensation,desire to defecate,and maximum tolerance)were lower after neoadjuvant radiotherapy.And maximum tolerance was significantly lower(66.0[49.0,88.0]ml vs.52.0[39.0,73.5]ml,Z=-2.481,P=0.013).Univariate analysis demonstrated that the downstage of N-stage was associated with the decrease in maximum tolerance(OR=6.533,95%CI:1.254-34.051,P=0.026).Conclusion Neoadjuvant radiotherapy damages anorectal function by decreasing the resting pressure and rectal sensory threshold of patients.The N-stage downstaging was associated with a decrease in maximum tolerance.

关 键 词：直肠肿瘤 新辅助放疗 肛门功能 肛门直肠测压 

分 类 号：R735.37[医药卫生—肿瘤]