新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响

Effects of neoadjuvant chemoradiotherapy on anal sphincter function for intersphincteric resection with low rectal cancer

目的:进展期的低位直肠癌行新辅助治疗可明显降低局部复发,但是也可能会带来肛门功能的受损。本研究探讨新辅助治疗对经内外括约肌间切除术(intersphincteric resection,ISR)术后肛门功能的影响程度。方法:选取2005年9月至2011年3月中国医科大学附属盛京医院103例行ISR手术的低位直肠癌患者,按照是否接受术前新辅助治疗分为CRT组(术前放化疗组)和对照组,通过向量测压、Saito功能问卷和Wexner评分来比较两组的肛门功能。结果:CRT组的术前静息向量容积和收缩向量容积要明显低于对照组,术后两组的测压结果均显著下降,CRT组的所有指标均低于对照组(P<0.05)。在6、12个月Saito功能问卷结果除排便困难两组间没有差异外,其余CRT组结果均明显不如对照组;在术后24个月,排便频率、排便截断、气便分辨能力以及限制饮食4项CRT组仍不及对照组(P<0.05)。到术后24个月,两组Wexner评分均有下降趋势,CRT组高于对照组(P<0.05)。结论:对于需行ISR手术的低位直肠癌,新辅助治疗会明显的影响术后的肛门功能,而且这种影响要至少会持续2年时间。

Objective：To evaluate the effects of neoadjuvant chemoradiotherapy on anal function after intersphincteric resection （ISR） with low rectal cancer. Methods：A total of 103 patients were classified into the chemoradiotherapy （CRT） group and control group according to whether they received neoadjuvant chemoradiotherapy. Anal function was assessed using vectorial manometry, Saito function questionnaires, and Wexner incontinence scores. Results：The resting vector volume and squeezing vector volume of the CRT group were significantly lower than those of the control group prior to the operation. Both groups showed decreasing manometric re-sults after ISR. However, all indices of the CRT group were significantly lower than those of the control group （P〈0.05）. At 6 and 12 months after operation, the Saito questionnaire results reveal poor function for the CRT group compared with the control group, except for dyschesia. After 24 months, the stool frequency, ability to distinguish between feces and flatus, fragmentation, and alimentary re-striction remained poor for the CRT group （P〈0.05）. Although both groups showed decreasing Wexner scores with time, the score of the CRT group remained significantly higher than that of the control up to 24 months after operation. Conclusion：Neoadjuvant chemo-radiotherapy significantly affects the anal sphincter function for intersphincteric resection with low rectal cancer. This effect continues for at least 2 years after operation.