直肠癌患者预防性肠造口还纳术后短期肛门功能情况评估

Assessment of short-term recovery of anal function after protective defunctioning stoma in rectal cancer

目的评估接受预防性肠造口直肠癌患者术后短期肛门功能恢复情况，为长期预后提供依据。方法采用Weber、Vaizey、Pescatori、AMS四种肛门功能评估量表对19例患者首次手术及还纳术后3个月的肛门功能进行评估，评估术后肛门功能恢复情况。结果不同年龄、性别、肿瘤分期的患者其术后肛门功能量表得分无明显差异，四种量表评分结果具有统计学正相关性。1例患者接受永久性造口，其余18例患者术后3个月Weber、Vaizey、Pescatori、AMS量表得分高于首次手术之前，其中Wexner量表得分（3．39±1．03与0．44±0．20，P：0．011），气体（Z=－3．742，P〈0．001）、液体（Z=－4．085，P〈0．001）和固体失禁（Z=－2．000，P=0．046）得分均较术前升高，提示患者还纳术后3个月的肛门功能较首次手术前差；而衬垫使用（P=0．344）及生活方式改变（P＝0．144）差异无统计学意义，说明患者术后的生活方式并未受到明显影响。结论接受预防性造口的直肠癌患者肛门功能较术前有一定程度的下降，但是患者生活方式并未发生明显改变，肛门功能仍在可接受范围内。

Objective The aims of the study were to assess anal function of patients with rectal cancer 3 month after the stoma was closed, and to provide basis for long-term prognosis. Methods 19 patients with rectal cancer who attended the Gastrointestinal surgery Center of West China Hospital of Sichuan University, determined to have protective defunctioning stoma, were included. Patients were interviewed with questionnaires on anal function using theWexner, Vaizey, Pescatori, AMS Inconti- nence Scales, Clinical information, including site, size, and stage of primary tumor, diagnosis, and basic information, inclusive of age, gender was extracted from electronic case record. Mean Wexner scores of 3 months after the stoma was closed were compared wit those of before the first surgery. Results 18 eligible patients, except 1 patient with permanent stoma, responded to the whole ques- tionnaires were included in outcome analysis. No difference was found in patients with different ages, genders, stages of tumors. In the correlation study among scales showed that any two of the four scales were well correlated. In comparison with Wexner scores before the first surgery, Wexner scores 3 months after the stoma was closed were significantly higher（3. 39 ＋ 1.03 VS 0. 44 ＋ 0. 20,P = 0. 011）. Incontinences of gas （Z = - 3. 742, P^0. 001 ）, liquid（Z = - 4. 085, P^0. 001 ） and solid（Z = - 2. 000, P = 0. 046）were worse than those of before the surgery, and the incidents increased were 16. 7%, 33. 3~//oo, and 16. 7%, respectively. No significant difference was found in frequency of using diapers（P = 0. 344）and changing of life style between the two periods. Conclusions Short-term recovery after the stoma closed was not optimistic in patients with rectal cancer, among which liquid incontinence was the most serious problem.