超低位直肠癌保肛手术后肛门直肠功能变化的研究

Research of anorectal function of ultra-low rectal carcinoma treated by anus-preserving operation

目的探讨超低位直肠癌患者行保肛手术后肛门直肠功能的变化。方法回顾性分析32例超低位直肠癌患者施行保肛手术的临床资料,于手术前及手术后3个月、6个月、12个月分别采用肛管直肠压力测定方法和徐忠法肛门功能检测标准进行肛门直肠功能评估。结果所有患者术后肛门排便功能明显下降,其中以术后3个月内肛门功能最差,术后6个月、12个月肛门功能逐渐恢复。肛管静息压、肛管最大收缩压、肛管最大收缩时间、肛管直肠抑制反射消失数在术后3个月、6个月与术前相比,差异均有统计学意义(均P<0.05);术后3个月、6个月、12个月各组间比较,差异也均有统计学意义(均P<0.05);术后12个月与术前相比差异无统计学意义(P>0.05)。结论超低位直肠癌行保肛手术后早期肛门功能明显下降,但随着时间的推移,大多数肛门功能可逐渐恢复。对超低位直肠癌患者施行保肛手术是可行的。

Objective To study the changes of anorectal function of patients suffered from rectal cancer after conducting ultra-low rectal anastomosis. Methods 32 patients who received ultra-low rectal anastomosis were retrospectively analyzed. The anorectal pressure measurement and XUZHONGFA Ana J—Function＇s criteria were used respectively to evaluate the preoperative anorectal function and its function 3 months,6 months and 12 months after operation. Results The anal resting pressure（ ARP）,the maximal squeezing pressure（ MSP） and the maximal squeezing time（ MST） of the 3rd and the 6th month were significantly lower than that of preoperative data（ P 〈0. 01）; but these indexes of the 12 th month have no obvious difference with the preoperative（ P〉 0. 05）. 3 months after surgery,the rectoanal inhibitory reflexes（ RAIR） of 78%（ 25 /32） patients were absent; 12 months after surgery,81%（ 26 /32） patients restored RAIR. Patients were hard to handle defecation at early period postoperation（ fine / excellent rate 18. 8%） and most patients increased their anal function12 months after the surgery（ fine / excellent rate 75%）. Conclusions The anorectal function impaired obviously at early postoperative period,and it was restored in most patients gradually. Anus-preserving operation is feasible and practical for patients who suffered from rectal cancer.