Kegel运动并生物反馈对直肠癌ISR术后肛门功能的影响

EFFECT OF KEGEL EXERCISE COMBINED WITH BIOFEEDBACK THERAPY ON ANAL SPHINCTER FUNCTION OF PATIENTS WITH INTERSPHINCTERIC RESECTION FOR ULTRA-LOW RECTAL CANCER

目的探讨Kegel运动联合生物反馈训练对超低位直肠癌经括约肌间切除术(ISR)后肛门功能的影响。方法将60例超低位直肠癌病人随机分为观察组和对照组,每组30例,均行ISR。观察组术后1周~3个月进行Kegel运动,术后2周开始做生物反馈训练;对照组术后2周开始单纯做生物反馈训练,均训练2个疗程。观察两组病人术后1、3、6、12个月的排便动力学指标(包括肛管静息压、肛管最大收缩压、直肠最大耐受容量)以及术后肛门排便功能指标,采用Wexner排便失禁评分系统评价排便控制良好病人的比率。结果两组病人术后1、3、6、12个月的直肠最大耐受容量差异无统计学意义(P>0.05);观察组病人术后1、3、6、12个月的肛管静息压和肛管最大收缩压均高于同期对照组,差异有统计学意义(F=2.953~5.116,P<0.05);观察组病人术后6、12个月肛管最大收缩压、肛管静息压恢复到接近术前水平,差异无统计学意义(P>0.05);对照组病人术后12个月肛管最大收缩压恢复到接近术前水平,差异无统计学意义(P>0.05);对照组病人术后12个月肛管静息压仍低于术前,差异有统计学意义(F=92.380,P<0.05)。随访12~36(平均21.6)个月,观察组和对照组病人中分别有89.7%(26/29)和64.3%(18/28)排便控制良好,两组差异有统计学意义(χ^(2)=5.208,P<0.05)。结论Kegel运动联合生物反馈训练可有效改善超低位直肠癌ISR术后肛门功能,且安全无创,病人易于接受,适于推广应用。

Objective To observe and evaluate the effect of Kegel exercise combined with biofeedback therapy on anal sphincter function of patients with intersphincteric resection for ultra-low rectal cancer.Methods Sixty ultra-low rectal cancer patients who underwent intersphincteric resection were randomly assigned to the experimental group and the control group,with 30 patients in each group.Patients in the experimental group performed Kegel exercise from 1 week to 3 months after operation and received 2 courses of biofeedback therapy from 2 weeks after operation.Patients in the control group received 2 courses of biofeedback therapy alone from 2 weeks after operation.Anorectal dynamic parameters were observed at 1,3,6,and 12 months after operation,including anal resting pressure(ARP),anal maximum squeeze pressure(AMSP),and rectal maximum tolerable volume(RMTV).We also observed the functional index of postoperative anal defecation.Wexner incontinence scale was used to evaluate the rate of good control of defecation.Results There were no significant differences in RMTV between the two groups at 1,3,6,and 12 months after operation(P>0.05).ARP and AMSP of the experimental group were significantly higher than those of the control group at 1,3,6,and 12 months after operation(F=2.953-5.116,P<0.05).AMSP and ARP in the experimental group were close to the preoperative levels at 6 and 12 months after operation,without significant differences(P>0.05).AMSP of the control group was similar to the preoperative level at 12 months after operation(P>0.05).ARP of the control group was still significantly lower than the preoperative level at 12 months after operation(F=92.380,P<0.05).All patients were followed up for 12-36(21.6)months;89.7%(26/29)and 64.3%(18/28)of patients in experimental and control groups showed good defecation control,respectively,with a significant difference between groups(χ^(2)=5.208,P<0.05).Conclusion Kegel exercise com-bined with biofeedback therapy can effectively improve the anal sphincter function of patients with ultra-low rectal cancer after intersphincteric resection.The treatment is safe,noninvasive,well-tolerated,and suitable for popularization and application.