术前放化疗对直肠癌括约肌间切除术后肛门功能的影响

Effect of preoperative chemoradiotherapy on anal function in patients with rectal cancer after intersphincteric resection

目的评估术前放化疗是否会降低接受肛门括约肌间切除术(intersphincteric resection,ISR)的低位直肠癌患者术后的肛门功能。方法收集89例低位直肠癌患者,根据患者所接受的治疗方式分为手术组41例和放化疗组48例。手术组患者直接接受ISR治疗,放化疗组在术前接受长程放化疗。所有患者均临时性回肠造口。所有患者均在术前1周和术后6个月时进行肛门直肠测压检查,并于术后6个月进行前切除综合征评分。结果放化疗组患者放化疗后最大缩榨压(P=0.005)和残余压(P=0.007)均减低,排便的最大耐受量也降低(P=0.040)。术后6个月时放化疗组患者的静息压(OR=1.024,P=0.047)、排便感觉阈(OR=1.035,P=0.045)和最大耐受量(OR=1.030,P=0.011)减低的程度均大于手术组。26例(29.2%)患者在术后6个月时回肠造口不能还纳。通过前切除综合征评分表评估患者术后的症状发现,放化疗后的患者术后前切除综合征发生率增高(80.5%vs 66.7%),但其严重程度与手术组比较,差异无统计学意义(P=0.091)。结论术前放化疗会降低ISR术后肛门功能,降低生活质量。

Objective To evaluate whether preoperative chemoradiotherapy would reduce anal function in patients with low rectal cancer after intersphincteric resection(ISR). Methods Eighty-nine patients with low locally advanced rectal cancer underwent ISR. According to the preoperative therapy, patients were divided into two groups: the operation group(n=41), patients received ISR directly;and the chemoradiotherapy group(n=48), patients received long-term chemoradiotherapy before opeartion. All patients had a temporary ileostomy. All patients underwent anorectal manometry at 1 week before operation and 6 months after operation, and low anterior resection syndrome(LARS) score was performed 6 months after operation. Results The maximal compressive pressure(P=0.005) and residual pressure(P=0.007) were significantly decreased after chemoradiotherapy. Meanwhile, the maximal tolerant dose of defecation is also decreased(P=0.040). The decrease of resting pressure(OR=1.024, P=0.047), defecation sensory threshold(OR=1.035, P=0.045) and maximal tolerance(OR=1.030, P=0.011) in the chemoradiotherapy group at 6 months postoperatively were significantly greater than those in the operation group. The ileostomy in 26 patients(29.2%) cannot be closed at 6 months postoperatively. According to the LARS score, patients treated with chemoradiotherapy suffered more low anterior syndrome(80.5% vs 66.7%). However, the severity in the two groups had no significant difference(P=0.091). Conclusion Preoperative chemoradiotherapy can decrease anal function and quality of life after ISR.