保肛术后吻合口位置与肛门功能关系的分析

Relationship of rectal anastomotic position and anal function

目的探讨保肛术后吻合口位置与肛门功能的关系。方法选取96例行保肛手术的低位直肠癌患者并随机分为三组各32例,即低位吻合组(吻合口距齿状线≥2 cm),超低位吻合组(吻合口距齿状线<2 cm)、肛管吻合组(结肠贮袋肛管吻合),在三组患者术前、术后3、6及12个月分别采用肛管直肠测压(Anorectal Manometry)技术进行肛门功能客观指标的评价,评价参数包括肛管静息压(ARP)、肛管最大缩榨压(MSP)、最大耐受容量(MTV)、直肠抑制反射(RAIR),同时采用徐忠法进行术后肛门功能的主观评价,评分级别分为优、良、中、差。结果三组患者术后3个月时ARP、MSP、MTV、RAIR正常比例均明显低于术前,但超低位组降低更显著,低位组其次,肛管吻合组降低程度最低,组间比较差异显著。超低位组术后12个月时ARP、MTV、RAIR正常比例仍未恢复至术前,而肛管吻合组约在术后3个月基本恢复至正常,低位组在术后6个月时即基本恢复至正常。在术后3、6及12个月时,肛管吻合组肛门功能明显优于其他两组,且肛管吻合组术后3个月时肛门功能基本恢复,而超低位组在术后12个月时仍有部分患者肛门功能受损。结论低位直肠癌患者保肛手术吻合口越高,肛门功能恢复越好,尤其是肛管吻合时肛门功能恢复最为显著。

Objective To investigate relationship of rectal anastomotic position and anal function. Methods 96 low colorectal cancer patients undergoing rectal surgery were randomly divided into three groups 32 cases for each group,namely low anastomosis group( anastomosis from the dentate line ≥2 cm),ultra-low anastomosis group( anastomosis from the dentate line < 2 cm),anal anastomosis group( colon pouch anal anastomosis). Before surgery,3 months,6 months and 12 months after surgery anorectal manometry was used to evaluate the objective indicators of anal function,the evaluation parameters including anal resting pressure( ARP),the maximum reduction anal virgin pressure( MSP),the maximum tolerated volume( MTV),rectal inhibitory reflex( RAIR),meanwhile Xuzhong method was used to evaluate the subjective postoperative anal function,ratings level being divided into excellent,good,fair,poor. Results Three months after surgerg,ARP,MSP,MTV,RAIR normal ratio were significantly lower than those before,but ultralow group decreased more significantly,followed by the low group and anal anastomosis group,with significant difference. In ultralow group 12 months after surgerg ARP,MTV,RAIR normal ratio had not yet returned to the preoperative levels but in anal anastomosis group about three months after surgery they returned to normal,in the low group 6 months after surgery they returned to normal. Three months,6 months and 12 months after surgery,anal function was of the anal anastomosis group was significantly better than the other two groups,which was restored,but in ultralow group 12 months after surgery there were still some anal functions impaired. Conclusions As for low sphincter preserving surgery patients with colorectal cancer the higher the anastomotic site the better the functional recovery of the anus,especially for anal anastomosis work the recovery of the anal function is the most significant.