腹腔镜超低位直肠癌经括约肌间切除术后肛门控便机制变化的研究

doi:10.3877/cma.j.issn.1674-0793.2018.03.012

目的

探讨腹腔镜超低位直肠癌经括约肌间切除（ISR）术后肛门控便机制变化的规律。

方法

选择2014年6月至2016年6月间29例腹腔镜超低位直肠癌ISR术患者为治疗组，分别于术后1、3、6、12个月时进行肛门失禁Wexner评分，与肛管测压、代直肠静息容量测定相结合以评估患者的排便功能，同时设立健康成人对照组，进行统计学分析。

结果

肛门失禁Wexner评分显示，治疗组术后1、3、6、12个月均与对照组差异有统计学意义（P<0.01），治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=182.4，P<0.001）。患者肛管压力测定显示，治疗组术后1、3、6个月的最大静息压、最大收缩压均明显低于对照组（P<0.05），治疗组内术后3、6、12个月的最大静息压均与上一个检测时间点差异有统计学意义（F=25.029，P<0.05）。代直肠静息容量测定显示，治疗组所有检测时间点的静息向量容积、收缩向量容积均明显低于对照组（均P<0.001），治疗组内术后3、6、12个月均与上一个检测时间点差异有统计学意义（F=4 640.715、3 421.403，均P<0.001）。

结论

低位直肠癌经括约肌间切除术的患者肛门控便功能是一个逐渐恢复的过程，术后12个月左右达到或接近正常水平。

关键词: 直肠肿瘤, 括约肌切开术，内窥镜, 控便, 超低位

Objective

To explore the regularity of bowel control after laparoscopic intersphincteric resection (ISR) for ultra-low rectal cancer.

Methods

Between June 2014 and June 2016, twenty nine patients with laparoscopic ISR for ultra-low rectal cancer were selected as the study objects (experimental group). The Wexner score of anal incontinence, anorectal manometry and the resting volume determination of rectum were used to evaluate anal function in experimental group and control group (healthy adults) at 1, 3, 6, 12 months after operation.

Results

Experimental group and control group were significantly different 1, 3, 6, 12 months after the operation by the Wexner incontinence score (P<0.01). In experimental group, 3 months vs 1 month and 6 months vs 3 months and 12 months vs 6 months after operation were significantly different (F=182.4, P<0.001). Experimental group and control group were significantly different 1, 3, 6 months after the operation by anorectal manometry (P<0.05). In experimental group, 3 months vs 1 month and 6 months vs 3 months and 12 months vs 6 months after operation were significantly different by Maximum resting pressure (F=25.029, P<0.05). Experimental group and control group were significantly different 1, 3, 6, 12 months after the operation by resting volume determination of rectum (all P<0.001). In experimental group, 3 months vs 1 month and 6 months vs 3 months and 12 months vs 6 months after operation were significantly different (F=4 640.715, 3 421.403, both P<0.001).

Conclusion

Anal continence is a gradual recovery process for patients with lower rectal cancer undergoing resection of the sphincter, which can reach or close to normal level one year after surgery.

Key words: Rectal neoplasms, Sphincterotomy, endoscopic, Anal continence, Ultra-low

表1 治疗组与对照组肛门失禁Wexner评分比较（29例）

组别		肛门失禁Wexner评分	t值^a	P值^a
对照组		0.24±0.13
治疗组
	术后1个月	11.28±2.83	21.1	<0.001
	术后3个月	5.72±1.96	15.0	<0.001
	术后6个月	4.69±1.23	19.6	<0.001
	术后12个月	0.45±0.36	3.37	0.002

表1 治疗组与对照组肛门失禁Wexner评分比较（29例）

组别		肛门失禁Wexner评分	t值^a	P值^a
对照组		0.24±0.13
治疗组
	术后1个月	11.28±2.83	21.1	<0.001
	术后3个月	5.72±1.96	15.0	<0.001
	术后6个月	4.69±1.23	19.6	<0.001
	术后12个月	0.45±0.36	3.37	0.002

表2 治疗组与对照组肛管压力及代直肠向量容积测定（29例）

组别		最大静息压(mmHg)	t值^a	P值^a	最大收缩压(mmHg)	t值^a	P值^a
对照组		52.15±12.33			117.27±26.27
治疗组
	术后1个月	22.24±7.12^a	9.764	<0.001	76.26±23.54^a	6.162	<0.001
	术后3个月	33.52±12.07^a,b	5.156	<0.001	89.45±24.77^a,b	4.258	<0.001
	术后6个月	38.41±15.30^a,b	3.184	0.002	94.66±31.97^a,b	2.541	0.014
	术后12个月	46.35±18.45^b	0.428	0.670	104.17±31.25^b	1.419	0.161
组别		静息向量容积[cm×(cmHg)²]	t值^a	P值^a	收缩向量容积[cm×(cmHg)²]	t值^a	P值^a
对照组		588.9±24.67			891.6±39.92
治疗组
	术后1个月	89.55±25.18^a	76.862	<0.001	123.1±42.31^a	72.767	<0.001
	术后3个月	175.34±34.54^a,b	54.305	<0.001	273.3±53.55^a,b	52.221	<0.001
	术后6个月	248.53±42.12^a,b	32.001	<0.001	384.3±64.94^a,b	35.098	<0.001
	术后12个月	356.83±44.26^a,b	25.616	<0.001	576.6±69.52^a,b	22.299	<0.001

表2 治疗组与对照组肛管压力及代直肠向量容积测定（29例）

组别		最大静息压(mmHg)	t值^a	P值^a	最大收缩压(mmHg)	t值^a	P值^a
对照组		52.15±12.33			117.27±26.27
治疗组
	术后1个月	22.24±7.12^a	9.764	<0.001	76.26±23.54^a	6.162	<0.001
	术后3个月	33.52±12.07^a,b	5.156	<0.001	89.45±24.77^a,b	4.258	<0.001
	术后6个月	38.41±15.30^a,b	3.184	0.002	94.66±31.97^a,b	2.541	0.014
	术后12个月	46.35±18.45^b	0.428	0.670	104.17±31.25^b	1.419	0.161
组别		静息向量容积[cm×(cmHg)²]	t值^a	P值^a	收缩向量容积[cm×(cmHg)²]	t值^a	P值^a
对照组		588.9±24.67			891.6±39.92
治疗组
	术后1个月	89.55±25.18^a	76.862	<0.001	123.1±42.31^a	72.767	<0.001
	术后3个月	175.34±34.54^a,b	54.305	<0.001	273.3±53.55^a,b	52.221	<0.001
	术后6个月	248.53±42.12^a,b	32.001	<0.001	384.3±64.94^a,b	35.098	<0.001
	术后12个月	356.83±44.26^a,b	25.616	<0.001	576.6±69.52^a,b	22.299	<0.001

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Study of shift mechanism of bowel control after laparoscopic intersphincteric resection for ultra-low rectal carcinoma

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Study of shift mechanism of bowel control after laparoscopic intersphincteric resection for ultra-low rectal carcinoma