低位直肠癌保肛术后合并低位前切除综合征患者盆底功能改变初探

Preliminary Study of the Patients with Anterior Resection Syndrome after Anus-Preserving Surgery for Low Rectal Cancer

目的分析低位直肠癌保肛术后发生低位前切除综合征(LARS)患者的肛门直肠形态学及动力学变化并探究LARS发生机制。方法前瞻性搜集术后发生LARS患者22例并纳入实验组,所有患者于手术前后均行盆腔动态MRI及3D高分辨肛门直肠测压(HR-ARM)检查;选取22名健康成年人为对照组,亦行盆腔动态MRI及3D HR-ARM检查,比较实验组术前、术后及与对照组的盆腔动态MRI及3D HR-ARM各观测指标间差异,分析两项检查各指标间的相关性。结果实验组术前动态MRI测得静息相和力排相M线大于对照组(P<0.05);实验组术后三个时相的肛直角均大于术前(P<0.05);实验组术后三个时相的肛直角、H线、M线均大于对照组(P<0.05);实验组术前3D HR-ARM压力性指标大于对照组(P<0.05),术后则与对照组无明显差异;实验组术前3D HR-ARM感觉性指标小于对照组(P<0.05),术后感觉性指标进一步降低。术前部分盆腔动态MRI指标与3D HR-ARM指标之间具有相关性。结论LARS患者术前即有盆底松弛及直肠感觉脱敏的趋势,经过手术对肠管及盆底肌群的损伤后,这一趋势加重。

Objective To analyze the changes of anus and rectum morphology and dynamics in LARS patients after anus-preserving surgery for low rectal cancer and explore the mechanism of LARS.Methods A prospective study of 22 patients with LARS after operation was included in the experimental group.All patients underwent pelvic dynamic MRI and 3 DHR-ARM examination before and after the operation.22 healthy adults were used as the control group,and pelvic dynamic MRI and 3 DHR-ARM examination was performed.We compared the differences between the experimental groups preoperative and postoperative pelvic dynamic MRI observation indexes with the control group.We compared the differences between the 3 DHR-ARM observation indexes of the experimental group before operation,after operation and with the control group.We then analyzed the correlation between the indicators of the two inspections.Results The preoperative M line on resting phase and defecation phase were greater than those of control group(all P<0.05).The postoperative ARA on three phases of LARS patients were greater than preoperative results(all P<0.05).The postoperative ARA、H line、M line on three phases of LARS patients were greater than those of control group(all P<0.05).Preoperative stress index of 3 DHR-ARM in LARS group were higher than those of control group.Preoperative sensory index of 3 DHR-ARM in LARS group are lesser than those in control group and further reduced in the postoperative period.A partial pelvic dynamic MRI indicator has correlation with 3 DHR-ARM preoperative indicators.Conclusion Patients with LARS have a tendency to relax the pelvic floor and desensitize rectal sensation before surgery.This tendency is increased after surgery to the intestine and pelvic floor muscles.