个体化生物反馈训练对直肠癌保肛术后肛门直肠动力学和肛门排便功能的影响

Intervention effect of personalized biofeedback therapy for anorectal dynamics and defecation dysfunction in patients with rectal cancer after restorative resection

目的:探讨个体化生物反馈训练对直肠癌保肛术后肛门直肠动力学和肛门排便功能的影响,旨在寻找一种有效预防低位前切除综合征的方法。方法:将2017年1月至2018年6月在复旦大学附属华山医院行低位直肠癌根治术的100例患者按照随机数字表分为干预组和对照组各50例,最终完成研究87例,其中干预组45例,对照组42例。对照组术后给予常规护理,干预组实施个体化生物反馈疗法,治疗3个月后开始随访。分别于随访后1、3、6个月比较2组患者肛管静息压、直肠静息压、肛管最大收缩压、直肠初始感觉容量、直肠便意感觉容量、直肠最大耐受容量等肛肠动力学指标,并评价2组患者肛门排便功能。结果:术前、随访第1个月2组患者各肛肠动力学指标比较差异无统计学意义( P>0.05);随访第3个月,干预组直肠静息压、直肠初始感觉容量、直肠最大耐受容量分别为(6.65 ± 1.70) mmHg(1 mmHg=0.133 kPa)、(27.18 ± 4.21) ml、(114.59 ± 23.72) ml,明显低于对照组的(7.65 ± 1.72) mmHg、(20.78 ± 5.76) ml、(100.65 ± 17.73) ml,差异均有统计学意义( t值为2.753、5.941、3.087, P<0.01);随访第6个月干预组肛管静息压、直肠静息压、肛管最大收缩压、直肠初始感觉容量、直肠便意感觉容量、直肠最大耐受容量分别为(34.06 ± 8.95) mmHg、(4.54 ± 1.24) mmHg、(147.07 ± 32.08) mmHg、(31.10 ± 5.80) ml、(45.77 ± 8.74) ml、(130.99 ± 25.67) ml,明显低于对照组的(29.12 ± 7.02) mmHg、(5.80 ± 1.30) mmHg、(128.60 ± 27.26) mmHg、(26.23 ± 5.39) ml、(40.92 ± 7.21) ml、(109.17 ± 25.02) ml,差异均有统计学意义( t值为2.808~4.641, P<0.01)。术前及随访1、3个月,干预组和对照组排便功能比较差异无统计学意义( P>0.05);随访6个月,干预组排便功能明显优于对照组,差异有统计学意义( Z值为2.306, P<0.05)。 结论:个体化生物反馈训练能加速恢复直肠癌保肛术患者术后直肠功能,缓解患者术后排便功能障碍症状,值得推广应用。

Objective To investigate the effect of personalized biofeedback therapy for anorectal dynamics and defecation dysfunction in patients with rectal cancer after restorative resection,and to explore the useful method to prevent low anterior resection syndrome.Methods Rectal cancer patients in hospital from January 2017 to June 2018 were enrolled in the present study,who were going to undergo sphincter-preserving surgery.They were randomly divided into control group and intervention group.Participants in the control group received routine nursing,while the intervention group carried out personalized biofeedback therapy for three months.After 1th month,3th month,6th month of followed-up,the anorectal dynamics index such as anal resting pressure,rectal resting pressure,maximum systolic pressure,initial rectal volume,rectal fecal sensory capacity,rectal maximum tolerance capacity were compared between two groups,in addition,the defecation function were also evaluated.Results Preoperative,after 1th month of followed-up,the anorectal dynamics index was no significant difference between intervention group and control group(P>0.05).After 3th month of followed-up,the rectal resting pressure was significantly decreased[(6.65±1.70)mmHg vs(7.65±1.72)mmHg]and initial rectal volume,rectal maximum tolerance capacity was significantly increased in the intervention group compared to the control group[(27.18±4.21)ml,(114.59±23.72)ml vs(20.78±5.76)ml,100.65±17.73)ml](all P<0.05).After 6th month of followed-up,the rectal resting pressure was significantly decreased[(4.54±1.24)mmHg vs(5.80±1.30)mmHg]and anal resting pressure,maximum systolic pressure,initial rectal volume,rectal fecal sensory capacity,rectal maximum tolerance capacity was significantly increased[(34.06±8.95)mmHg,(147.07±32.08)mmHg,(31.10±5.80)ml,(45.77±8.74)ml,(130.99±25.67)ml vs(29.12±7.02)mmHg,(128.60±27.26)mmHg,(26.23±5.39)ml,(40.92±7.21)ml,(109.17±25.02)ml]in the intervention group compared to the control gorup(all P<0.05).There was no significant difference of defecation function between intervention group and control after 1th,3th month of followed-up(P>0.05),however,the defecation function was better in the intervention group compared to the control group(P<0.05).Conclusion Personalized biofeedback can significantly improve the anorectal dynamics of patients with rectal cancer after restorative resection,promote the defecation dysfunction syndrome,which is worthy of popularization and application.