生物反馈治疗中低位直肠癌保肛术后排粪失禁

Biofeedback therapy for fecal incontinence in patients with mid or low rectal cancer after restorative resection

目的 探讨生物反馈治疗对于中低位直肠癌术后排粪功能障碍的疗效.方法 对24例中低位直肠癌术后排粪功能障碍的患者予以生物反馈治疗（治疗组）,进行治疗前后直肠肛管压力检测及肛管功能评分（Vaizey评分和Wexner评分）,并与同期住院的18例无排粪功能障碍患者（对照组）进行比较.结果 治疗组患者术后肛管静息压（27.8＋9.0）mm Hg,最大收缩压（118.3±42.9）mm Hg,直肠初始感觉容量（19.0±6.1）ml,直肠最大耐受容量（97.5±52.8）ml;显著低于对照组的（55.7±8.5）mm Hg、（233.2±31.7）mm Hg、（25.8±4.4）ml和（229.3±39.7）ml（均P〈0.01 ）.经生物反馈训练后,肛管静息压、最大收缩压和直肠最大耐受容量显著性提高,分别为（47.9±9.3）mm Hg、（193.2±38.2）mm Hg和（189.1±39.0）ml（P〈0.01）,而直肠初始感觉容量未见明显增加[（21.5±4.8）ml,P=0.101].治疗组患者生物反馈治疗前的Vaizey评分和Wexner评分为12.9±2.8和10.1±2.6;治疗后显著降低,分别为10.5±2.3和7.5±2.5（P〈0.01）.结论 生物反馈治疗方法可以改善直肠癌保肛手术后肛门功能障碍.

Objective To investigate the efficacy of biofeedback therapy for fecal incontinence in patients with mid or low rectal cancer. Methods Twenty-four patients with mid or low rectal cancer received biofeedback treatments after restorative resection and therapeutic efficacy was evaluated using anorectal manometry and Vaizey and Wexner scoring systems. Eighteen inpatients without defecating difficulties were selected as control group. Results The parameters of anorectal manometry in patients with rectal cancer were significantly lower than those in the control group（P〈0.01）.Mter biofeedback therapy,the maximum squeeze pressure,resting pressure and maximum tolerated volume were significantly increased,from（118.3±42.9）mm Hg to（193.2±38.2）mm Hg,（27.8±9.0）mm Hg to （47.9±9.3）mm Hg,（97.5±52.8）ml to（189.1±39.0）ml,respectively（all P〈0.01）,while no significant difference in sensory threshold was observed（P=0.101）.Post-treatment Vaizey（10.5±2.3 vs 12.9±2.8） and Wexner （7.5±2.5 vs 10.1±2.6）scores were significantly decreased compared with those before biofeedback（P〈0.01）.Conclusion Biofeedback therapy can impmve the anal function in patients with rectal cancer after restorative resection.