超低位直肠癌保肛手术对肛门功能影响的临床研究

Clinical study on the effect of anal sphincter preservation surgery on anal function in ultralow rectal cancer

目的探讨超低位直肠癌保肛手术对肛门功能的影响。方法选择2015年7月至2018年7月深圳市人民医院诊治的63例超低位直肠癌手术患者为研究对象,根据手术方式将患者分为三组:A组实施开腹直肠癌前切除术或内括约肌间切除术,B组实施腹腔镜下直肠癌前切除术或内括约肌间切除术,C组术前给予新辅助放化疗。按照相应标准进行疗效评价。结果与术前比较,术后3个月肛管的缩榨压、平均静息压及最大静息压,A组、B组及C组均显著降低(均P<0.05);与术后3个月相比较,术后6个月各组检测值显著提高(均P<0.05);与术前相比较,术后1年B组及C组检测值差异无统计学意义(P>0.05),但A组的平均静息压及最大静息压明显降低(P<0.05)。术后3个月、术后6个月及术后1年A组、B组及C组Wexner评分逐渐降低,各组间差异均有统计学意义(均P<0.05).结论超低位直肠癌行腹腔镜手术有利于保护肛门功能,而术前新辅助放化疗对肛门功能的保护起到积极作用。

Objective To investigate the effect of anal sphincter preservation on ultra-low rectal cancer on anal function,and compare the changes of postoperative anal function in each group.It is clear that the ultra-low rectal cancer sphincter preservation operation is closely related to the recovery of postoperative anal function.Methods Sixty-three patients with ultralow rectal cancer who underwent surgery in our hospital from July 2015 to July 2018 were enrolled in the study.Patients were divided into three groups according to the surgical procedure:group A underwent open rectal anterior resection or internal sphincter.In the group B,laparoscopic rectal anterior resection or internal sphincter resection was performed.Group C received neoadjuvant chemoradiotherapy before operation.The efficacy was evaluated according to the corresponding criteria.Results Anal canal compression pressure,mean resting pressure and maximum resting pressure were significantly lower in group A,group B and group C than in preoperative group(all P<0.05).The detection value was significantly higher than that at 3 months after operation(P<0.05).The detection values of group B and group C were close to preoperative(P>0.05),but the mean resting pressure and maximum resting pressure of group A were still significant.Lower than preoperative(P<0.05).The Wexner scores of group A,group B and group C decreased gradually at 3 months,6 months and 1 year after operation,and the difference between the groups was statistically significant(all P<0.05).Conclusion Ultra-low rectal cancer Anal sphincter surgery is closely related to postoperative anal function recovery.Laparoscopic surgery is beneficial to protect anal function,and preoperative neoadjuvant radiotherapy and chemotherapy plays an active role in the protection of anal function.