盆底肌注射肉毒毒素预防低位直肠癌手术吻合口瘘的应用研究

Application of Botulinum Toxin Injection to Prevent Anastomotic Fistula in Patients with Low Rectal Cancer

目的探讨盆底肌注射肉毒毒素预防低位直肠癌手术吻合口瘘的应用效果,对药物安全性进行分析。方法选取我院收治的经肠镜检查确诊为低位直肠癌并择期行Dixon手术治疗的120例患者,按照随机数字表法分为两组,各60例。对照组患者术后行肛管持续冲洗,并进行负压引流,观察组在对照组的基础上加用肉毒毒素盆底肌注射。对比两组患者术后3 d切口的疼痛指数及住院时间,观察两组患者治疗1个月后盆底肌肌力变化以及术后吻合口瘘等并发症的发生情况。结果两组患者手术结束清醒后疼痛指数评分无明显差异(P>0.05),术后3 d,观察组疼痛指数明显低于对照组(P<0.05);观察组术后住院时间明显短于对照组(P<0.05);治疗前,两组患者的盆底肌肌张力、快、慢肌肌力、慢肌耐力无明显差异(P>0.05),治疗后,观察组盆底肌肌力明显低于对照组(P<0.05);观察组患者无不良反应发生,术后并发症的总发生率为6.7%,对照组患者术后并发症发生率为16.6%,差异有统计学意义(P<0.05),其中观察组吻合口瘘的发生率亦明显低于对照组(P<0.05)。结论肉毒毒素盆底肌注射不仅可降低低位直肠癌术后患者的盆底肌肌力,预防吻合口瘘,亦能减轻患者切口疼痛,缩短肛门排气时间以及术后住院时间,临床上应当进一步推广应用。

Objective To investigate the effect of botulinum toxin injection into pelvic floor muscles in preventing anastomotic leakage in low rectal cancer patients, and to analyze the safety of drugs. Methods A total of 120 patients with low rectal cancer diagnosed by enteroscopy and selected for Dixon operation were divided into two groups according to random number table method, 60 cases in each group. Patients in the control group underwent continuous irrigation in the anal canal and negative pressure drainage, while those in the observation group received botulinum toxin pelvic floor muscle injection on the basis of treatment of the control group. The pain index of incision at 3 d after operation and the total hospitalization time were compared between the two groups. The changes of pelvic floor muscle strength and the occurrence of postoperative anastomotic leakage complications were observed after one month of treatment. Results There was no significant difference in pain index when patients regained consciousness after operation between the two groups(P>0.05). The pain index of the observation group was significantly lower than that of the control group at three days after operation(P<0.05). The postoperative hospitalization time of the observation group was significantly shorter than that of the control group(P<0.05). Before treatment, there was no difference in the pelvic floor muscle tension,strength of fast-and slow-twitch muscles and endurance of slow-twitch muscle(P>0.05). After treatment, the pelvic floor muscle strength of the observation group was significantly lower than that of the control group(P<0.05). No adverse reactions were found in the observation group.The incidence of postoperative complications was statistically lower in observation group(6.7%) than in control group(16.6%)(P<0.05). The incidence of anastomotic leakage was also significantly lower in the observation group than in the control group(P<0.05). Conclusion Pelvic floor muscular toxin injection can not only reduce pelvic floor muscle strength and prevent anastomotic leakage, but also relieve incision pain and shorten postoperative hospitalization time for patients with low rectal cancer. It should be further applied in clinic.