Objective: To evaluate the impact on manometric results of anorectal function after transanal endoscopic microsurgery for benign rectal tumor and early rectal cancer. Methods: 30 patients with rectal tumors who had received transanal endoscopic microsurgery from February 2008 to February 2010 were followed up. Anorectal manometric tests were applied 1 week preoperatively and 2 weeks, 3, 6 and 9 months postoperatively to evaluate their anorectal functions. The results were compared by using student t test and x2 test. Results: Of these 30 patients, preoperative biopsy showed that 20 had villous adenomas and 10 had adenocarcinomas (8 T1 and 2 T2) where located from 5 cm to 16 cm above the anal verge. Compared with preoperative results, the mean resting pressure and the maximum tolerable volume had significant reductions at 3rd month after surgery (t=17.4, 22.8, P＜0.05) and achieved preoperative levels at 6th month (t=1.75, 0.93, P＞0.05). The squeezing pressure decreased significantly 2 weeks after surgery (t=24.0, P＜0.05) and returned to normal at 3rd month (t=1.65, P＞0.05). A significant reduction of the rectal volume at sensory threshold was observed within the first 6 months postoperatively (t=3.38, P＜0.05) and it returned to normal at 9th month (t=1.40, P＞0.05). The rectoanal inhibitory reflexes were absent in 3 patients preoperatively and the number increased significantly to 14 at 3rd month postoperatively(x2=9.93,P＜0.05). There remained only 4 patients with negative reflexes 6 months postoperatively which close to preoperative results (x2=0.16, P＞0.05). Conclusion: Although manometric results of anorectal function were compromised within a short period after transanal endoscopic microsurgery,they approached to normal levels at about 9th month suggesting transanal endoscopic microsurgery is an effective and promising method for benign and early malignant rectal tumors.%目的:探讨直肠良性肿瘤及早期直肠癌经肛门内窥镜微创手术(TEM)治疗后对肛门功能的影响.方法:随访2008年2月至2010年2月30例经肛门内窥镜微创术治疗的直肠肿瘤患者,于术前1周,术后2周、3个月、6个月和9个月时采用肛门测压法评估肛门功能.统计数据采用t检验和x2检验进行比较.结果:30例患者中,术前经活检证实绒毛状腺瘤20例,直肠腺癌10例(T1期8例,T2期2例),肿瘤距肛缘为5～16 cm.与术前相比,术后3个月平均静息压和最大耐受容量均较术前降低,差异有统计学意义(t=17.4、22.8,P<0.05),至术后6个月时恢复正常(t=1.75、0.93,P>0.05);缩榨压于术后2周时降低,与术前相比差异有统计学意义(t=24.0,P<0.05),术后3个月恢复正常(t=1.65,P>0.05);直肠容量感觉阈值于术后6个月内降低,与术前相比差异有统计学意义(t=3.38,P<0.05),至术后9个月趋于正常(t=1.40,P>0.05).术前有3例未引出直肠肛门抑制反射,术后3个月有14例阴性,差异有统计学意义(X2=9.93,P<0.05),术后6个月下降至4例,与术前相近(X2=0.16,P>0.05).结论:对于直肠良性肿瘤及早期直肠癌患者,采用TEM治疗后9个月起肛门测压结果基本正常,证明TEM不但是一种保肛及微创手术,而且对肛门功能影响很小.
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