直肠癌术后肛门外括约肌神经电生理研究

Electroneurophysiological observations on the external anal sphincter after rectal carcinoma operation

目的:通过对会阴-肛门反射弧脊髓中枢传导时间的检测,探讨直肠癌患者术后支配肛门外括约肌神经功能的改变。方法:对52例患者进行会阴-肛门反射、脊髓肛门反应和马尾神经诱发电位3种潜伏期检测,对会阴-肛门反射弧的传入、传出和脊髓中枢3部分神经传导情况进行定量分析,并与20例正常人进行比较。结果:正常人脊髓中枢传导时间为(17.8±6.5)ms,传入神经传导时间为(7.2±6.3)ms,传出神经传导时间为(8.2±6.1)ms,直肠癌术后患者各种反射潜伏期均有不同程度延长,传入和传出神经传导时间延长更明显,潜伏期与临床评分有明显的负相关性(r=0.691)。结论:直肠癌术后患者支配肛门外括约肌神经功能异常是影响临床疗效的重要因素,神经损害在会阴-肛门反射弧的传入和传出神经最严重。

AIM:To explore the functional damage of the nerves controlling external anal sphincter in patients with rectal carcinoma by detecting the conductive time of sacral spinal center in the pudendo anal reflex arc. METHODS:In the pudendo anal reflax, the spinal anal response and the evoked potential of caude equine were detected simultaneously in fifty two patients with anorectal cancer.The conduction time of afferent motor nerve, efferent sensenerve and sacral spinal center in the pudendo anal reflax arc were quantitively analysized and compared with 20 normal persons. RESULTS:The normal conduction time of afferent motor nerve was (17.8±6.5) ms, for efferent sensenerve was (7.2±6.3) ms,and for sacral spinal center was (8.2±6.1) ms.In patients with postoperation anorectal cancer, the latencies were prolonged obviously, especially the conduction time of afferent motor nerve and efferent sense nerve. There was a significant negative correlation between the latency and clinical scores (r=0.691). CONCLUSION: The abnormality of nerves serving anal sphincters is one of the important causes for postoperative anal function. The neural lesions are specially serious in the afferent motor nerve and efferent sense nerve in pudendo anal reflax.