低位直肠癌术后吻合口位置与肛门功能关系的研究*

摘要

目的：探讨保肛术后吻合口位置与肛门功能的关系。方法：选取湖南省人民医院2008年1月至2011年11月间行低直肠癌保肛手术的82例患者，根据吻合口位置，将病例分为5组，吻合口距离肛缘距离用L表示：Ⅰ组：L≤3 cm，Ⅱ组：3 cm6 cm。对所有患者术前及术后肛门功能进行主、客观评定，同时设立未涉及盆底及肛门部手术操作的降结肠、乙状结肠肿瘤手术患者为对照组。结果：从肛门直肠测压评估方法可以得出：1）对照组和各组患者术前各项指标比较无统计学差异（P>0.05）；2）Ⅰ～Ⅳ组术后3个月平均静息压、最大静息压、缩榨压和最大耐受容量较术前显著降低（P<0.05）；3）Ⅱ、Ⅲ、Ⅳ组术后12个月各项指标即接近正常值（P>O.05）；4）Ⅰ组术后12个月平均静息压、最大静息压、最大耐受容量仍较术前低（P<0.05），但缩榨压接近正常值（P>O.05）；5）对照组有1例患者未引出RAIR（Recto anal inhibitory reflex），各组手术后均有（RAIR）消失，但术后12个月RAIR阳性率较术后3个月明显增加。采用徐忠法的肛门功能主观评估法得出：Ⅰ～Ⅴ组患者术后优良率与对照组相比差异有统计学意义（P<0.05）的分别是：1）术后3个月时有：Ⅰ、Ⅱ、Ⅲ组；2）术后6个月时有：Ⅰ、Ⅱ组；3）术后12个月时仅：Ⅰ组；4）其余组与对照组比较差异无统计学意义。结论：在严格遵循保肛手术的适应证及由熟练的手术者操作的前提下、采用合适的术式，吻合口距离肛缘3 cm以上的直肠癌患者术后经过长时间（1年）的修复或排便锻炼都可以保住肛门功能，吻合口距离肛缘5～6 cm以上的直肠癌术后3个月即可基本恢复肛门功能。%This study aims to investigate the relationship between anastomosis location and anal function in low rectal cancer anus preservation operation. Methods:We chose 82 cases from patients who underwent rectal cancer anus preservation operation between January 2008 and November 2011. The cases were divided into five groups based on the anastomosis location, the distance between the anastomosis location, and the anal edge with L replaced:GroupⅠ:L≤3 cm, GroupⅡ:3 cm6 cm. The anal function of the patient before and after the operation was assessed using objective and subjective standards. The control group was set as well (descending colon and sigmoid colon cancer surgery patients who did not undergo pelvic floor and anus department operation). Results:Based on the Anorectal Manometry methods, the following conclusion can be drawn:GroupsⅠtoⅢhave obvious anal function damage at the early postoperative period (3 months). After a year of repair and defecation exercises, GroupⅠstill have anal function damage. Each index of groupⅤwas close to the normal level three months after the operation. The following conclusions were also drawn based on the Xu ZhongFa anus function methods:obvious anal function damage are as follows:GroupsⅠ-Ⅲ;GroupⅢcan partially restore the anal function six months after the operation. GroupⅡcan partially restore the anal function one year after the operation;and Group I still has anal function damage one year after the operation. Conclusion:Skilled surgeons operate on the premise that strictly follows the anus preservation operation indications by using the appropriate procedure. The anal function of patients with rectal cancer whose distance between anastomosis location and anal edge was above 3 cm can be preserved through one year of repair and defecation exercises after the operation. Moreover, the anal function of those whose distances between anastomosis location and anal edge were more than 5 cm to 6 cm can be recovered three months after the operation.