CAJ | 학술논문

目的探讨超低位直肠肿瘤经括约肌间切除术( intersphincteric resection,ISR)后内括约肌不同缺失程度对大便失禁的影响.方法选取71例直肠肿瘤患者分别行低位前切除术、部分ISR、次全ISR、完全ISR,依次作为A组(内括约肌完整组)、B组(内括约肌缺失1/3组),C组(内括约肌缺失2/3组),D组(内括约肌完全缺失组),采用肛门直肠测压和Vaizey评分系统跟踪随访4组患者术后1年内大便失禁程度的动态变化,并用重复测量方差和多元方差分析对数据进行分析.结果术后4组肛管高压区长度均有不同程度缩短,随着术后时间推移高压区长度略有延长,但至术后12个月4组之间差异仍有统计学意义(F=41.873,P=0.000).4组肛管最大静息压均明显下降,至术后12个月时有不同程度恢复:A组恢复至接近术前水平；B、C组皆升至约术前2/3水平,两组差异无统计学意义(P=0.30)；D组升至术前的1/3水平.术后10d时4组患者均出现Vaizey评分上升,此后B、C两组下降趋势相同,术后12个月时两组差异无统计学意义(P =0.158),并接近于A组；D组至术后12个月为13.7±3.2.多元回归分析显示,术后12个月,肛管最大静息压、肛管高压区长度与大便失禁的主观评分Vaizey评分呈负相关(t=-4.802,P=0.000;t=-2.011,P=0.048).结论超低位直肠肿瘤患者术后12个月内大便失禁严重程度Vaizey评分与肛管最大静息压、肛管高压区长度相关.术后一年时绝大多数超低位直肠肿瘤切除患者可获得比较满意的控便功能.
목적 탐토초저위직장종류경괄약기간절제술( intersphincteric resection,ISR)후내괄약기불동결실정도대대편실금적영향.방법 선취71례직장종류환자분별행저위전절제술、부분ISR、차전ISR、완전ISR,의차작위A조(내괄약기완정조)、B조(내괄약기결실1/3조),C조(내괄약기결실2/3조),D조(내괄약기완전결실조),채용항문직장측압화Vaizey평분계통근종수방4조환자술후1년내대편실금정도적동태변화,병용중복측량방차화다원방차분석대수거진행분석.결과 술후4조항관고압구장도균유불동정도축단,수착술후시간추이고압구장도략유연장,단지술후12개월4조지간차이잉유통계학의의(F=41.873,P=0.000).4조항관최대정식압균명현하강,지술후12개월시유불동정도회복:A조회복지접근술전수평；B、C조개승지약술전2/3수평,량조차이무통계학의의(P=0.30)；D조승지술전적1/3수평.술후10d시4조환자균출현Vaizey평분상승,차후B、C량조하강추세상동,술후12개월시량조차이무통계학의의(P =0.158),병접근우A조；D조지술후12개월위13.7±3.2.다원회귀분석현시,술후12개월,항관최대정식압、항관고압구장도여대편실금적주관평분Vaizey평분정부상관(t=-4.802,P=0.000;t=-2.011,P=0.048).결론 초저위직장종류환자술후12개월내대편실금엄중정도Vaizey평분여항관최대정식압、항관고압구장도상관.술후일년시절대다수초저위직장종류절제환자가획득비교만의적공편공능.
Objective To investigate the influence of internal sphincter deletions on postoperative fecal incontinence in rectal cancer patients after intersphincteric resection (ISR). Methods Seventy one cases of rectal tumour were respectively treated by low anterior resection (group A, intact internal sphincter),partial ISR (group B,1/3 internal sphincter deletion),subtotal ISR (group C,2/3 internal sphincter deletion) and total ISR (group D,total internal sphincter deletion).Anorectal manometry and Vaizey scoring system were used to trace dynamic changes of fecal incontinence in the four groups in one year follow up. Data were analyzed with repeated-measures analysis of variance and multivariate analysis of variance. Results In all cases the length of postoperative anal high-pressure zone shortened by groups.With time the length of high-pressure zone increased slightly.By the end of postoperative 12 months,there were still significant differences between groups( F =41.873,P =0.000).The maximum resting pressure of anal canal significantly reduced in all groups.By the end of postoperative 12 months,it almost restored to preoperative level in group A,while in group B and C it was about 2/3 of the preoperative level; and 1/3 of the preoperative level in group D.Vaizey score at postoperative 10 days,increased in all groups.In group B and C the score was on continuous decrease until the end of postoperative 12 months(P =0.158) it was close to that in group A.While in group D it was only 13.7 ±3.2 by the end of postoperative 12 months.Multiple regression analysis showed that by the end of postoperative 12 month,the maximum resting pressure of anal canal and postoperative anal high-pressure zone length were significantly and negatively related with the subjective Vaizey score of fecal incontinence ( t =- 4.802,P =0.000 ; t =- 2.011,P =0.048 ).Conclusions In patients of ultra-low rectal cancer undergoing intersphincteric resection,fecal incontinence severity indicator vaizey score as evaluated by the end of postoperative 12 months was associated with the maximum resting pressure of anal canal and anal high-pressure zone length.In addition,postoperative fecal incontinence severity carries reversible dynamic changes, and with time, most patients could restore satisfactory stool control function.