提肛运动和排便反射训练改善低位直肠癌保肛术后肛门功能的临床研究

Training for Elevating Anal Muscle and for Defecation Reflex in the Improvement of Anal Function Following Reserved-anus Procedure for Low Rectal Carcinoma

为探讨提肛运动训练和排便反射训练改善低位直肠癌保肛术后肛门功能的效果，将80例拟行保肛术治疗的低位直肠癌患者随机分为观察组和对照组，各40例。观察组患者在常规护理基础上由造口治疗师指导进行提肛运动训练和排便反射训练，提肛运动训练从入院第2天开始，术前1天至术后2周暂停，手术2周后继续，训练分3个阶段进行，共12个月；排便反射训练从术后1个月开始。对照组患者接受常规护理。对比分析两组患者术后3、6、12个月时观察组的肛门排便控便情况及肛门直肠测压结果。结果显示，观察组术后3个月肛门排便控便功能优于对照组，P〈0．05；术后6、12个月肛门排便控便功能明显优于对照组，P〈0．01。两组术后肛管静息压、肛管最大收缩压、直肠最大耐受容量均逐渐升高，其中观察组各指标恢复更快，术后12个月时各指标基本恢复正常。结果表明，提肛运动训练和排便反射训练可促进低位直肠癌保肛术后肛门功能的恢复，改善患者生活质量。

In order to investigate the efficacy of training for elevating anal muscle and [or defecation reflex in the improvement of anal function following reserved-anus procedure for low rectal carcinoma, authors di- vided randomly 80 cases to be subjected to reserved-anus procedure into observation group and control group,40 cases each groups^on the basis of conventional nursing the former took above training under di- rection of neostomy surgeon,i, e training for elevating anal muscle started from the second day after admit- ted in hospital, ended till the day before operation, and two weeks after operation again started two weeks after operation, this training was performed according to three phases, lasted for 12 monthes; while, training for defecation reflex started from one month after operation;the latter still received routine nursing. Then, the status of defecation and its control, and measurement of anal-rectal pressure at 3,6,12 months after op- eration were compared and analyzed between both groups. As results,in the function of defecation and its control at three months, and 6,12 months after operation, observation group was s urperior, and significant- ly superior to control group（ p 〈0.05 ,and P 〈0.01） ;postoperative anal rest pressure,maximum systolic pressure, and rectal maximum tolerance volume of both groups were all elevated gradually, but above all in- dexes of observation group recovered fasterly,and nearly to normal till at 12 month after operation. Results show that above training can promote recovery of postoperative anal function, so that improve the patient＇squality of life.