Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correct...Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.展开更多
随着科学技术的进步,腹腔镜技术的应用越来越广泛。研究表明[1],腹腔镜手术较开腹手术具有术后疼痛轻、康复快、切口小等优点。1982年英国学者Heald等[2]提出了全直肠系膜切除术的概念,因其能有效降低局部复发率,目前已成为直肠癌根治...随着科学技术的进步,腹腔镜技术的应用越来越广泛。研究表明[1],腹腔镜手术较开腹手术具有术后疼痛轻、康复快、切口小等优点。1982年英国学者Heald等[2]提出了全直肠系膜切除术的概念,因其能有效降低局部复发率,目前已成为直肠癌根治术的金标准。但对于肥胖男性、骨盆狭窄、内脏容积高的低位直肠癌而言,腹腔镜并未很好地发挥其优势。对于超低位直肠癌,经腹会阴联合切除Miles术[3]为主要术式,但永久性造瘘会导致患者生活质量极度下降,因此对于保肛的呼声越来越高。自2010年Sylla等完成第1例经肛门全直肠系膜切除术(transanal total mesorectal excision,TaTME)以来,TaTME已成为直肠癌根治性手术领域的新热点之一[4]。TaTME实现了“由下往上”逆行的操作步骤,更直接地进入直肠系膜间隙,避免暴露不佳导致的盆腔神经副损伤,符合经自然腔道内镜手术的理念,在真正实现超低位保肛的同时保证了环周切缘阴性。根据有无腹腔镜辅助,TaTME又分为完全TaTME与杂交TaTME,杂交TaTME即需要通过腹腔镜辅助完成。如何加强TaTME手术室的医护配合是手术室护士需要关注的重点,为探讨最佳的护理配合方法,现将我院开展的腹腔镜辅助TaTME的13例低位直肠癌患者的临床资料及护理配合体会报道如下。展开更多
文摘Tests for evaluating incontinence include endoanal ultrasound(EUS)and anorectal manometry.We hypothesized that EUS would be superior to anorectal manometry in identifying the subset of patients with surgically correctable sphincter defects leading to an improvement in clinical outcome in these patients.The purpose of this study was to compare these 2 techniques to determine which is more predictive of outcome for fecal incontinence.Thirty-five unselected patients with fecal incontinence were prospectively studied with EUS and anorectal manometry to evaluate the internal anal sphincter(IAS)and external anal sphincter(EAS).EUS was performed with Olympus GFUM20 echoendoscope and a hypoechoic defect in the EAS or IAS was considered a positive test.Anorectal manometry was performed with a standard water-perfused catheter system.A peak voluntary squeeze pressure of < 60 mm Hg in women and 120 mm Hg in men was considered a positive test.All patients were administered the Cleveland Clinic Continence Grading Scale at baseline and at follow-up.Improvement in fecal control was defined as a 25%or greater decrease in continence score.EUS versus manometry were compared with subsequent surgical treatment and outcome.P-values were calculated using Fisher’s exact test.Patients(n = 32;31 females)were followed for a mean 25 months(range 13-46).Sixteen patients had improved symptoms(50%).There was no correlation between EUS or anorectal manometry sphincter findings and outcome.Seven of 14(50%)patients who subsequently underwent surgery versus 9 of 18(50%)without surgery improved(P =.578).In long-term follow-up,approximately half of patients improve regardless of the results of EUS or anorectal manometry,or whether surgery is performed.
文摘随着科学技术的进步,腹腔镜技术的应用越来越广泛。研究表明[1],腹腔镜手术较开腹手术具有术后疼痛轻、康复快、切口小等优点。1982年英国学者Heald等[2]提出了全直肠系膜切除术的概念,因其能有效降低局部复发率,目前已成为直肠癌根治术的金标准。但对于肥胖男性、骨盆狭窄、内脏容积高的低位直肠癌而言,腹腔镜并未很好地发挥其优势。对于超低位直肠癌,经腹会阴联合切除Miles术[3]为主要术式,但永久性造瘘会导致患者生活质量极度下降,因此对于保肛的呼声越来越高。自2010年Sylla等完成第1例经肛门全直肠系膜切除术(transanal total mesorectal excision,TaTME)以来,TaTME已成为直肠癌根治性手术领域的新热点之一[4]。TaTME实现了“由下往上”逆行的操作步骤,更直接地进入直肠系膜间隙,避免暴露不佳导致的盆腔神经副损伤,符合经自然腔道内镜手术的理念,在真正实现超低位保肛的同时保证了环周切缘阴性。根据有无腹腔镜辅助,TaTME又分为完全TaTME与杂交TaTME,杂交TaTME即需要通过腹腔镜辅助完成。如何加强TaTME手术室的医护配合是手术室护士需要关注的重点,为探讨最佳的护理配合方法,现将我院开展的腹腔镜辅助TaTME的13例低位直肠癌患者的临床资料及护理配合体会报道如下。