中低位直肠癌患者低位前切除术对肛门直肠功能影响研究

The effect of low anterior resection on anorectal function in patients with middle and low rectal cancer

目的：研究中低位直肠癌患者手术对肛门直肠功能的影响。方法：选择2012年1月至2015年1月在我院就诊的中低位直肠癌患者100例,患者肿瘤远侧缘距肛缘距离≤5cm为低位组,肿瘤远侧缘距肛缘距离5-10 cm为中位组,低位组、中位组患者各50例,所有患者均采用低位前切除术,采用Hida肛门直肠临床功能评分系统对两组患者的肛门直肠功能进行评分,观察患者排便情况,采用肛门直肠功能压力检测仪对患者进行检测。结果：术后低位组患者每日出现便失控、每周出现便失控、排气失控、排液性便失控、排固性便失控等发生率均显著高于中位组,中位组中偶尔便失控、排便功能正常发生率高于低位组,低位组患者排便功能较中位组差,差异有统计学意义（P〈0.05）,术前两组患者的肛门直肠临床功能评分比较差异无统计学意义（P〉0.05）,术后3、6、12个月时,低位组患者的肛门直肠临床功能评分较中位组高,差异有统计学意义（P〈0.05）;术后,中位组患者肛管最大收缩压、肛管静息压、肛管最大收缩时间、直肠肛门抑制反射压力下降等均显著高于低位组,低位组患者肛门直肠测压较中位组差,差异有统计学意义（P〈0.05）。结论：低位直肠癌患者手术后肛门直肠功能障碍较中位直肠癌患者显著,在中低位直肠癌患者治疗时,应全面评估患者肛门直肠功能,争取保留患者肛门功能。

Objective： To study the effect in patients with mid-low rectal cancer operation on anorectal function.Methods： 100 cases of patients with mid-low rectal cancer were selected from January 2012 to January 2015 years in our hospital, and patients with the distance from distal margin of tumor to the anal verge ≤5 cm were in low group, 5-10 cm in mid-low group, 50 cases in each. All patients were with low anterior resection, used HIDA anorectal clinical function evaluation system to evaluate anorectal function score of two groups; observed the patients’ defecation and tested the patients with anorectal function pressure tester.Results： After operation, incidence rate of daily out of control, weekly out of control, exhaust control, discharge of exhaust control, setting it out of control etc. in low group was signiifcantly higher than those of mid-low group. Occasionally out of control and the normal rate of bowel function of mid-low group were higher than those of the low group; the defecation function of the low group was lower than that of the mid-low group, and the difference was statistically signiifcant （P〈0.05）. Before operation, the difference of clinical anorectal function score between the two groups showed no statistical signiifcance （P〉0.05）; 3, 6 and 12 months atfer operation, the anal rectal function scores in the low group was higher than that in the mid-low group, the difference was statistically significant （P〈0.05）. After surgery, anal maximal systolic blood pressure, anal resting pressure, anal maximal contraction time, rectoanal inhibitory relfex pressure drop of mid-low group were significantly higher in the low group, anorectal manometry ARM in low group was worse than that in mid-low group.Conclusion： Anorectal dysfunction atfer surgery in patients with low rectal cancer was signiifcant than those patients in mid group. In the treatment of patients with low rectal cancer, anorectal function should be comprehensive assessed, ifghting to preserve the anal function of patients.