Dixon保肛手术对低位直肠癌患者疗效、肛门直肠功能及应激反应的影响

Influences of Dixon anus preserving surgery on curative effect,anorectal function and stress response in patients with low rectal cancer

目的探讨Dixon保肛手术对低位直肠癌患者疗效、肛门直肠功能及应激反应的影响。方法回顾性分析2016年5月至2019年3月张家口市第五医院收治的150例低位直肠癌患者作为研究对象,按照手术方式的不同将患者分为研究组和对照组各75例,研究组患者行Dixon术,对照组患者行Miles术,比较两组患者手术一般情况、术后排尿功能、应激反应[C反应蛋白(CRP)、白细胞介素-6(IL-6)、皮质醇(Cor)及促肾上腺皮质激素(ACTH)]、肛门直肠功能[肛管静息压(ARP)、肛管最大收缩压(MSP)和肛管最长收缩时间(ALCT)]、生活质量评分(PAC-QOL评分)以及术后并发症发生率、局部复发率、远处转移率、3年无瘤生存率和3年总生存率。结果研究组患者手术时间、术中出血量、术后引流量显著低于对照组[(172.28±23.45)min比(189.57±23.68)min、(177.39±21.23)ml比(191.35±22.67)ml、(342.36±52.89)ml比(489.42±63.33)ml],差异有统计学意义(P<0.05);研究组患者术后CRP、IL-6、Cor及ACTH水平显著低于对照组[(22.35±4.75)mg/L比(35.65±5.28)mg/L、(58.74±15.11)μg/L比(79.63±20.23)μg/L、(145.36±27.48)ng/L比(156.48±32.55)ng/L、(44.58±5.27)ng/L比(49.62±5.68)ng/L],差异有统计学意义(P<0.05);研究组患者术后6个月排尿功能和肛门直肠功能显著优于对照组,PAC-QOL评分显著低于对照组[(22.53±2.86)分比(27.54±3.21)分],差异有统计学意义(P<0.05);研究组患者术后并发症发生率、局部复发率、远处转移率、3年无瘤生存率和3年总生存率与对照组比较差异无统计学意义(P>0.05)。结论Dixon术治疗低位直肠癌的疗效较好,可最大程度保留患者肛门直肠功能,保护排尿功能,降低患者应激反应,更有利于患者的快速康复。

Objective To investigate the influences of Dixon anus preserving surgery on the curative effect,anorectal function and stress response of patients with low rectal cancer.Methods A total of 150 patients with low rectal cancer admitted to Zhangjiakou Fifth Hospital from May 2016 to March 2019 were retrospective analysis as the study subjects.According to the different surgical methods,the patients were divided into the study group(75 cases)and the control group(75 cases).The patients in the study group received Dixon operation,and the patients in the control group received Miles operation.The general condition of operation,postoperative urination function,stress response[C reactive protein(CRP),interleukin-6(IL-6),cortisol(Cor)and adrenocorticotropic hormone(ACTH)],anorectal function[anal resting pressure(ARP),maximal squeeze pressure(MSP),anal longest contraction time(ALCT)],quality of life(PAC-QOL score),postoperative complications,local recurrence rate,distant metastasis rate,3-year tumor free survival rate and 3-year overall survival rate were compared between the two groups.Results The operation time,intraoperative blood loss and postoperative drainage volume in the study group were lower than those in the control group:(172.28±23.45)min vs.(189.57±23.68)min,(177.39±21.23)ml vs.(191.35±22.67)ml,(342.36±52.89)ml vs.(489.42±63.33)ml,there were statistical differences(P<0.05).The levels of CRP,IL-6,Cor and ACTH in the study group were lower than those in the control group:(22.35±4.75)mg/L vs.(35.65±5.28)mg/L,(58.74±15.11)μg/L vs.(79.63±20.23)μg/L,(145.36±27.48)ng/L vs.(156.48±32.55)ng/L,(44.58±5.27)ng/L vs.(49.62±5.68)ng/L,there were statistical differences(P<0.05).The urination function and anorectal function of the patients in the study group were obviously better than those in the control group 6 months after operation,and the PAC-QOL score was obviously lower than that in the control group:(22.53±2.86)scores vs.(27.54±3.21)scores(P<0.05);there was no obvious difference between the study group and the control group in the incidence of postoperative complications,local recurrence rate,distant metastasis rate,3-year tumor free survival rate and 3-year total survival rate(P>0.05).Conclusions Dixon operation is effective in the treatment of low rectal cancer.It can preserve the anorectal function of patients to the greatest extent,protect urination function,reduce stress reaction of patients,and it is more conducive to rapid rehabilitation of patients.