直肠癌前切除术后肛门直肠压力及功能在不同时期的变化.pdf

现代肿瘤医学2014年1月第22卷第1期 MODERN ONCOLOGY,Jan.2014,VOL.2,NO.01
直肠癌前切除术后肛门直肠压力及功能在不同时期的变化
龚海,潘燕,俞一峰,姚勇
Change in diferent period of the pressure of anorectum and metergasis after anterior rec
tol resection
Ig Hai, Pan Yan, Yu Yifeng, Yao Yong
Department of Colorectal Surgery, Jiangyin Pepoles Hospital of Southeast University, Jiangsu Jiangyin 214400 China
Abstract Objective: T approach the correlation of change in different period of pressure of anorectum and
metergasis before and after anterior rectal resection. Methods: Determine the pressure of anorectum about patients(n
46 ) with rectal cancer before and after Dixon, using anorectal manometry detection system with four passage water
infusing. Determine the resting pressure of rectum and anus, the maximal squeezing
essure
e maxima
squeezing time of anus, the rectoanal inhibi ory reflex after 3, 6, 12 months after operation. Results: Determine the
resting pressure of rectum and anus, the maximal squeezing pressure of anus, the maximal squeezing time of anus, the
reduce numerical of rectoanal inhibitory reflex after 3, 6months after operation were decreased compared with before
anterior rectal resection (P<0.05) Determine the resting pressure of rectum and anus, the maximal squeezing pres
sure of anus, the maximal squeezing time of anus, the rectoanal inhibitory reflex after 12months after operation were no
obvious difference before anterior rectal resection(P< 0.05).Conclusion: The anal canal function of self-control
and sphincter was decreased in patients with rectal cancer after anterior rectal resection because structure of the anal
canal has significant changes. But with time, the anus and control ability will rise gradually
Key words )anterior rectal resection; anorectal manometry; anal function
Modern Oncology2014,22(01):0139-0141
摘要】目的:探讨直肠癌前切除术前、术后不同时期肛肠压力与肛门功能发生改变的相关性。方法:采用4
通道水灌注式肛门直肠压力检测系统,对46例直肠癌患者进行术前、术后3、6、12个月测定肛管直肠静息压
肛管最大收缩压、肛管最大收缩时间、直肠肛门抑制反射压力下降值。结果:术后3、6月肛管直肠静息压、肛
管最大收缩压、肛管最大收缩时间、直肠肛抑制反射压力下降值较术前明显降低(P<0.05);术后12月肛
管直肠静息压、肛管最大收缩压、肛管最大收缩时间、直肠肛门抑制反射压力下降值与术前相比无明显差异
(P>0.05)。结论:直肠癌低位前切除术后,患者的肛门直肠结构发生明显的变化,因而肛门控便功能有所下
降。但随着时间的推移,肛门控便能力逐步上升。
【关键词)直肠癌前切除;肛门直肠压力;肛门功能
【中图分类号)R735
文献标识码】A
DOI:10.3969/j.issn.1672-4992.2014.01.45
文章编号】1672-4992-(2014)01-0139-0
直肠癌是胃肠道常见的恶性肿瘤之ー,每年发病率30-功能,一直是外科医师关注的热点间题。肛管直肠测压的方
50/10万り。而直肠癌前切除术是公认的兼顾根治性和保法在70年代初就开始用于肛肠外科疾病的病理生理研究和
证肛门功能的首选术式,但手术将改变肛广门]直肠正常的生理诊断?。近几年来,各种经典及改良的测压方法已广泛地应
解剖功能,特别是LAR患者术后有不同程度的便频、便急用于肛肠外科的各个领域,被公认为是重要的研究手段和肛
感、大便失禁等肛门排使功能失调,出现所谓的“LAR综合肠动力检査中实用和重要的诊断方法之一。本研究通过
征”2,从而影响患者的生活质量。如何既能将肿瘤根治,同术前、术后不同时期对患者肛门直肠压力的测定及肛门功能
时又最大限度的保留、重建肛『门,尽快恢复患者的直肠肛门的观察,提供了患者在直肠癌前切除术后肛门控便功能的
个客观评价
资料与方法
【收稿日期】2013-03-10
1.1一般资料
【作者单位】东南大学附属江阴市人民医院肛肠外科,江苏江阴
20090年8月-2010年5月间,我院开展的直肠癌 Dixon
214400
【作者简介)龚海(1973-),男,江苏江阴人,主治医师,主要从事
手术46例,所有患者术前诊断明确,均未接受放、化疗;术后
无吻合口瘘,吻合口狭窄等并发症。术后病理检查上下切缘
肛肠外科疾病基础与临床研究。E-mail: gonghai1973
均未见癌细胞。术后均住院复查及随访至少12个月。患者