不同内括约肌切除方案对低位直肠癌患者术后肛门功能影响的研究

Study on the effect of different intersphincteric resection on postoperative anal function in patients with low rectal cancer

目的探讨部分内括约肌切除术和全内括约肌切除保肛术对低位直肠癌患者术后肛门功能的影响。方法选取2012年1月至2014年7月低位直肠癌行部分内括约肌切除术患者40例为部分切除组,同期行全内括约肌切除保肛术的患者36例为全部切除组。门诊随访1年,于术后1、3、6、12个月进行肛门功能评价;术后6个月进行生活质量评价。结果术后1、3、6、12个月部分切除组患者肛门功能良好率均显著高于全部切除组(P<0.05或P<0.01)。两组社会功能、疼痛、睡眠紊乱、总健康状况和情感功能比较差异有统计学意义(P<0.05),而其他项目比较差异未见统计学意义(P>0.05)。结论部分内括约肌切除术可保留低位直肠癌患者肿瘤对侧部分括约肌和齿状线,最大限度避免了肛门失禁,有助于改善和提高患者术后肛门功能。

Objective To investigate the effect of different intersphincteric resection on postoperative anal function in patients with low rectal cancer.Methods Forty patients with low rectal cancer underwent partial intersphincteric resection from January 2012 to July 2014 were selected as partial group, and 36 patients with low rectal cancer underwent total intersphincteric resection were selected as total group.Postoperative 1, 3, 6, 12 months, the anal function of two groups were determined.Postoperative 6 months, the life quality were determined.Results Postoperative 1, 3, 6, 12 months, the good rate of anal function in partial group was significantly higher than that in total group （P〈0.05 or P〈0.01）.There were significant difference on social function, pain, sleep disorders, total health and emotional function between the two groups （P〈0.05）, and no significant differences in other items（P〉0.05）.Conclusion Partial intersphincteric resection of colorectal cancer, the sphincter and contralateral dentate line of low rectal cancer patients can be reserved, the maximum to avoid the incontinence, help improve and enhance the postoperative anal function.