直肠癌NOSES术对肛门功能的影响

Effect of colorectal natural orifice specimen extraction surgery on anal function

目的 探讨直肠癌NOSES手术对肛门功能的影响。方法 选择2017年7月至2020年7月诊治的53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随机分为经自然腔道取标本手术组(NOSES组,n=30),接受腹腔镜辅助经腹直肠(传统手术组,n=23)。按照相应标准进行疗效评价。比较2组不同时期的最大收缩压、平均静息压及最大静息压。比较2组不同时期的初始阈值,排便感觉阈值,最大耐受量。肛管直肠反射指标有:直肠肛门抑制反射。结果 与术前比较,2组术后4周最大收缩压、平均静息压及最大静息压,均显著降低(P<0.05),术后12周2组检测值显著提高(P<0.05);与术前比较,传统手术组及NOSES组术后24周检S测值接近(P>0.05),但传统手术组平均静息压及最大静息压仍显著低于术前(P<0.05);传统手术组、NOSES组术后4周初始阈值,排便感觉阈值,最大耐受量、直肠肛门抑制反射与术前相比均大幅降低(P<0.05);术后12周2组均有不同恢复,术后24周基本恢复正常术前水平;NOSES组与传统手术组相比各项指标相比恢复更快,更接近术前水平。传统手术组、NOSES组Wexner评分于术后4周、12周及24周逐渐降低,差异有统计学意义(P<0.05)。结论 NOSES术相比传统手术在促进术后恢复肛门功能方面疗效可靠,具有一定的临床推广应用价值。

Objective To investigate the effect of the colorectal natural orifice specimen extraction surgery(NOSES) on anal function.Methods A total of 53 patients with ultra-low colorectal cancer treated in our hospital from July 2017 to July 2020 were retrospectively analyzed.They were randomly to receive NOSES(NOSES group,n=30) and laparoscopic rectectom(conventional surgery group,n=23).The curative effect was evaluated according to the corresponding standards.The maximum systolic blood pressure(SBP),the average resting pressure and the maximum resting pressure,the initial threshold,defecation sensation threshold,and maximum tolerated dose were compared between the two groups.Rectoanal inhibition reflex was used as an anorectal reflex indicator.Results Compared with those before surgery,the maximum systolic blood pressure,average resting pressure,and maximum resting pressure in the both groups were significantly reduced at 4 weeks postoperatively(P<0.05),which were significantly enhanced at 12 weeks(P<0.05).The maximum systolic blood pressure were comparable between groups at 24h(P>0.05).However,the average resting pressure and maximum resting pressure in the conventional surgery group were significantly lower than those before surgery(P<0.05).The initial threshold,defecation sensation threshold,maximum tolerated dose and rectoanal inhibition reflex at 4 weeks postoperatively were significantly reduced in both groups than those before surgery(P<0.05).They were gradually enhanced at 12 weeks,and basically returned to baseline at 24 weeks.The recovery was significantly faster in NOSES group than that in conventional surgery group,and the index were more similar to preoperative levels.Wexner scores at 4,12 and 24 weeks in both groups were gradually reduced than those before surgery(P<0.05).Conclusion NOSES has a reliable effect on promoting the recovery of anal function after operation relative to conventional surgery,which is recommended to clinical application.