直肠癌腹腔镜或开腹低位前切除术后生物反馈治疗的疗效分析

Efficacy of biofeedback therapy after laparoscopic or traditional low anterior resection surgery for rectal cancer

目的分析比较腹腔镜与开腹手术对直肠癌低位前切除病人术后生物反馈治疗的疗效。方法 2014年6月至2015年12月对61例直肠癌术后接受生物反馈治疗的病人相关信息进行回顾性分析,其中腹腔镜手术30例,开腹手术31例。以每日排便次数、Vaizey评分量表、Wexner评分量表、肛管最大静息压(MRP)、肛管最大收缩压(MSP)、直肠初始容量感觉阈、直肠最大耐受容量作为评价指标。结果腹腔镜组的治疗效果显著优于开腹手术组,其中:腹腔镜组每日排便次数平均减少了3.67次/d,而开腹手术组则减少了1.39次/d,P<0.05;治疗前后肛管最大收缩压腹腔镜组增加了36.33 mmHg,而开腹手术组则增加了16.65 mmHg,P<0.05;治疗前后直肠最大耐受容量腹腔镜组增加了34.90ml,而开腹手术组则增加了14.74 ml,P<0.05。结论腹腔镜手术能够更好的保护神经,当接受生物反馈治疗时,病人由于神经完好,肛门功能能够得到更好的治疗效果。

Objective To compare the efficacy of biofeedback therapy after laparoscopic or tra- ditional low anterior resection surgery for rectal cancer. Methods Of the total data of 61 patients who received biofeedback after low anterior resection for rectal cancer, 30 （49%） cases were subjected to laparoscopy, and the remaining 31 （51%） were given a traditional trans-abdominal approach. The therapeutic effectiveness was compared in the evaluation of stool frequency, Vaizey Incontinence Ques- tionnaire, Wex_ner constipation score, maximal resting pressure （MRP）, maximal squeezing pressure （MSP）, sensory threshold of initial capacity and maximum tolerance capacity of rectum. Results Pa- tients benefited more from laparoscopic surgeries in terms of decreased bowel frequency of 3.67 times per day, increased MSP by 36. 33 mmHg and increased maximum tolerance capacity by 34. 90 mL, as compared with l. 39 times per day in reduction of bowel frequency （P〈0. 05）, 16. 65 mmHg of in- crease in MSP （P〈0. 05） and 14. 74 mL of increase in maximum tolerance capacity （P〈0. 05） in tra- ditional surgeries. Conclusions The better neuroprotection of laparoscopic surgeries may provide a possible hypothesis. Functions of anal sphincter recover better though well-preserved nerves when re- ceiving biofeedback therapy.