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

[1]	王峰，韩方海，马百柱, 等. 中低位直肠癌保留肛门括约肌手术与经腹会阴切除术的比较分析[J]. 中国普外基础与临床杂志, 2006, 13(2): 211.
[2]	Jorge JM, Wexner SD. Etiology and management of fecal incontinence[J]. Dis Colon Rectum, 1993, 36(1): 77-97.
[3]	邓海军，卿三华，李国新. 直肠癌安全切缘的研究进展[J]. 中华胃肠外科杂志, 1999, 2(3): 190.
[4]	Kazuo S, Isomoto H. Distal spread of rectal and optional distal margin of resection for sphincter-preserving surgery[J]. Cancer, 1995, 76: 388.
[5]	章斐然，李威，王怀明, 等. 腹腔镜全直肠系膜联合经肛门内括约肌切除治疗低位直肠癌的疗效探讨[J/CD]. 中华普通外科学文献（电子版）, 2014, 8(3): 204-208.
[6]	Braun J, Treutner KH, Winkeltau G, et al. Results of intersphincteic resection of the rectum with direct coloanal anastomosis for rectal carcinoma[J]. Am J Surg, 1992, 163(4): 407.
[7]	Matsuhashi N, Takahashi T, Tanahashi T, et al. Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor[J]. Oncol Lett, 2017, 14(4): 4142-4150.
[8]	Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer[J]. Ann Surg Oncol, 2014, 21 Suppl 3: S422-428.
[9]	Portier G, Ghoti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomsis with and without intersphincteric resection for low rectal adenocarcinoma[J]. Br J Surg, 2007, 94(3): 341-345.
[10]	Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer[J]. Ann Surg, 2007, 246(6): 916-921.
[11]	Gamagami R, Istvan G, Cabarrot P, et al. Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses[J]. Surgery, 2000, 127(3): 291-295.
[12]	Shibata D, Guillem JG, Lanouette N, et al. Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation thrapy, and sphincter preservation[J]. Dis Colon Rectum, 2000, 43(6): 752-758.
[13]	莫健文，谢莉萍，彭慧, 等. 直肠癌保肛术前肛门功能评估的初步调查研究[J/CD]. 中华普通外科学文献（电子版）, 2014, 8(3): 241-244.
[14]	Kakodkar R, Gupta S, Nundy S. Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome[J]. Colorectal Dis, 2006, 8(8): 650-656.
[15]	丛进春，戴显伟，张宏, 等. 超低位直肠癌经括约肌间切除术后的肛门功能评价[J]. 中国现代医学杂志, 2008, 18(6): 795-798.

[1]	王振宁, 杨康, 王得晨, 邹敏, 归明彬, 王雅楠, 徐明. 机器人与腹腔镜手术联合经自然腔道取标本对中低位直肠癌患者远期疗效比较[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 437-442.
[2]	赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[3]	吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4]	周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5]	徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[6]	李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7]	庄宝雄, 邓海军. 单孔+1腹腔镜直肠癌侧方淋巴结清扫术[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 601-601.
[8]	郑民华, 蒋天宇, 赵轩, 马君俊. 中国腹腔镜直肠癌根治术30年发展历程与未来[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 591-595.
[9]	池畔, 黄胜辉. 中国腹腔镜直肠癌根治术30年来的巨大进步[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 596-600.
[10]	李明, 屠松, 闫鹏, 钱军, 高鹏程, 许文山, 杨发英, 胡振涛, 单永玮. 应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 603-606.
[11]	李玲, 刘亚, 李培玲, 张秀敏, 李萍. 直肠癌患者术后肠道菌群的变化与抑郁症相关性研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 607-610.
[12]	赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[13]	吴胜伟, 王志伟, 陈贵进, 刘序, 吴晓翔. 系膜肥厚低位直肠癌患者改良NOSES Ⅰ式手术的临床效果评价[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 615-618.
[14]	严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[15]	赵磊, 刘文志, 林峰, 于剑, 孙铭骏, 崔佑刚, 张旭, 衣宇鹏, 于宝胜, 冯宁. 深部热疗在改善结直肠癌术后辅助化疗副反应及生活质量中的作用研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 488-493.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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