低位直肠癌保肛术后的吻合口水平对排便功能及生活质量的影响

Influence of anastomosis level on defection and life quality of patients underwent sphincter preservation for rectal cancer

目的:对低位直肠癌保肛手术患者进行问卷调查及肛门直肠测压,探讨吻合口水平对肛门排便功能和生活质量的影响.方法:对160例行低位前切除的直肠癌患者按吻合口距齿状线的距离分为三组(A组:0-1.0cm,B组:1.0-2.0cm,C组:2.0-3.0cm),分别在术后3mo及1年的进行Wexner评分、FIQL生活质量问卷等.选择30例无肛门直肠疾患、无排便功能障碍的正常志愿者为正常对照组.结果:在术后3mo,吻合口位置越低Wexner评分就越高(10.1vs6.1vs4.1,P<0.05),经1年的适应及功能锻炼后,各组的Wexner评分明显下降(10.1vs5.7,6.1vs3.1,6.1vs2.9,均P<0.05),A组评分仍然要高于B、C两组(5.7vs3.1,2.9,P<0.05),但后二者之间无显著差异.对自身生活质量满意方面,在术后1年三组患者的生活方式、心理应付/行为、抑郁/自我感受及窘迫尴尬无明显差异(P=0.294,0.477,0.138,0.857).结论:对于直肠癌的低位前切除术,吻合口位置越低肛门功能和生活质量就越差,对于吻合口距离齿状线小于1cm者,长期生存的生活质量明显下降.

AIM： To examine the influence of anastomosis level on defection and quality of life in low rectal cancer using a questionnaire and anus-rectal manometry. METHODS： We selected 160 patients who were divided into 3 groups according to the distance between anastomosis and dentate line （A： 0-1.0 cm, B： 1.0-2.0 cm, C： 2.0-3.0 cm）, who received evaluation with Wexner scoring systems at 3 months and at 1 year after operation, using FIQL questionnaire for quality of life and anusrectal vectorial manometry 1 year after operation. The normal controls were 30 healthy people without anus-rectal disease and disordered defecation. RESULTS： Lower anastomosis level meant higher Wexner scores （10.1 vs 6.1 vs 4.1, P 〈 0.05） at 3 mo after operation. After 1 year of adaptation and functional exercise, the scores of three groups decreased obviously （10.1 vs 5.7, 6.1 vs 3.1, 6.1 vs 2.9, all P 〈 0.05）. However, compared with B group and C group, A group still had significantly higher scores （5.7 vs 3.1, 2.9, P 〈 0.05）, but no differences were detected between B group and C group. As for quality of life satisfaction, three groups of patients showed no significant differences in life-style, psychological coping/ behavior, depression/self-feelings and embarrassing 1 year after operation. CONCLUSION： For the low anterior resection of rectal cancer surgery, the lower of the position of anastomosis, the worse of the function and the quality of life. For the distance between stoma and dentate line less than 1 cm, the long-term survival quality of life has also declined markedly.