低位直肠癌患者内括约肌切除术后肛门功能的评估

目的 探讨低位直肠癌内括约肌切除保肛手术对肛门功能的影响.方法 随访2005-2007年间27例低位直肠腺癌患者,手术前经MRI和腔内超声检查明确肿瘤为T0～T2期,距肛缘均＜5 cm(3～5 cm),行经腹和肛门内括约肌切除,结肠肛管直接吻合术.于手术前1周,手术后2周、3、6和9个月时应用肛门测压法对肛门功能进行评估.统计数据采用student t检验和X2检验进行比较.结果 27例患者术后3个月时肛门平均静息压(44±6)mm Hg降至(19±3)mm Hg、最大静息压(60±8)mm Hg降至(33±4)mm Hg、缩榨压(180±19)mm Hg降至(131±16)mmHg和最大耐受容量(165±20)ml降至(55±8)ml,均较术前显著降低(P＜0.05),直肠抑制反射均消失;手术后6个月平均静息压、最大静息压、缩榨压和最大耐受容量明显增加,6例可以引出直肠抑制反射;术后9个月平均静息压、最大静息压和缩榨压分别为:(41±5)mm Hg、(57±8)mm Hg和(173±19)mm Hg,均接近正常水平(P＞0.05),最大耐受容量增加至(110±16)ml,但仍较术前低(P=0.0153),11例直肠抑制反射阳性.结论 直肠内括约肌切除术后短期患者肛门功能明显受损,随手术后时间的延长,肛门功能可以完全恢复或接近手术前水平.

Postoperative rectoanal function in lower rectal carcinoma patients undergoing intersphincteric resection

Objective To investigate the changes of rectoanal function after intersphincteric resection(ISR). Methods In this study,27 lower(3～5 cm from anal verge)rectal adenocarcinoma patients(T0-T2 determined by MRI and endoanal uhrasonography before surgery)undergoing intersphincteric resection between January2005 and January 2007 were followed up,their rectoanal function was assessed by rectoanal manometry 1 week preoperatively and 2 weeks,3 months,6 and 9 months postoperatively.The data were compared by using student t test and X2 test.Results For these 27 patients,within 3 months after surgery,the mean resting pressures(44±6)mm Hg to(19±3)mm Hg,maximum resting pressures(60±8)mm Hg to(33±4)mm Hg,squeezing pressures(180±19)mm Hg to(131±16)mm Hg and msximum tolerable volume(165±20)ml to(55±8)nd were decreased significantly(P＜0.05),and the rectoanal inhibitory reflexes(BAIR)were all absent;6 months after surgery,the resting pressures,squeezing pressures and maximum tolerable volume began to increase obviously,and 6 patients presented RAIR;3 months later the mean resting pressures,maximum resting pressures and squeezing pressures were(41±5)mm Hg,(57±8)mm Hg and(173±19)mm Hg respectively,close to the normal range(P＞0.05),though the maximum tolerable volume increased to(110±16)mi,still lower than the preoperative value(P=0.0153),11 patients restored BAIR.Conclusions The rectoanal function is injured obviously after intersphincteric resection within a short time period,but with time it was gradually restored.