直肠肛门抑制反射在超低位直肠癌Lap-ISR后的变化及临床意义

Clinical significance of variation of rectoanal inhibitory reflex after laparoscopic intersphincteric resection for ultralow rectal cancer

目的探讨腹腔镜下超低位直肠癌经括约肌间切除术(Lap-ISR)后直肠肛门抑制反射(RAIR)的变化及其与肛门功能的关系。方法纳入2016年6月至2020年6月火箭军特色医学中心肛肠外科59名行Lap-ISR的直肠癌患者的临床资料。回顾性分析患者术前、回肠造口还纳前、还纳后3~6个月及12个月的RAIR参数变化特征及其与肛门功能的关系。肛门功能评估主要包括低位前切除综合征(LARS)评分和Wexner失禁评分。结果59名患者在术前、回肠造口还纳前、还纳后3~6个月及12个月引出RAIR的比率分别为95%(56/59)、34%(20/59)、46%(27/59)和61%(36/59)。RAIR的引出量在回肠造口还纳后12个月与术前相比显著增加(30 ml vs 20 ml,P=0.004),但RAIR的持续时间(7 s vs 10 s,P>0.05)和抑制深度(34.8%vs 38.5%,P>0.05)差异无统计学意义。回肠造口还纳后12个月,RAIR存在组(36例)与RAIR消失组(23例)相比,LARS评分(27分vs 34分,P=0.006)和Wexner失禁评分(6分vs 12分,P=0.001)均显著降低。结论Lap-ISR后大部分患者的RAIR消失,但伴随着时间的延长RAIR有逐渐恢复的趋势。术后RAIR的存在与较好的肛门功能相关。

Objective To investigate the variation of rectoanal inhibitory reflex(RAIR)after laparoscopic intersphincteric resection(Lap-ISR)for ultralow rectal cancer and its correlation with anorectal function.Methods Between June 2016 and June 2020,59 patients undergoing Lap-ISR for ultralow rectal cancer were enrolled.The variation of RAIR before the index operation,before ileostomy closure,and at 3~6 months and 12 months following ileostomy closure were analyzed.Anorectal function was evaluated by the LARS score and Wexner incontinence score at 12 months after ileostomy closure.Results The rates of presence of RAIR before the index operation,before ileostomy closure,and at 3~6 months and 12 months following stoma closure were 95%(56/59),34%(20/59),46%(27/59),and 61%(36/59),respectively.The elicited volume of RAIR was significantly increased at 12 months after ileostomy closure than that at baseline(30 ml vs 20 ml,P=0.004),but its duration(7 s vs 10 s,P>0.05)and amplitude(34.8%vs 38.5%,P>0.05)did not differ significantly.At 12 months after ileostomy closure,both the LARS score(27 points vs 34 points,P=0.006)and Wexner incontinence score(6 points vs 12 points,P=0.001)were significantly lower in the RAIR-present group than in the RAIR-absent group.Conclusion The RAIR is abolished in the majority of patients after Lap-ISR,but a time-dependent recovery could be observed.The presence of RAIR correlates with better continence.