CAJ | 학술논문

目的检测3种不同治疗方法下低位直肠癌经肛内外括约肌间切除术(ISR)患者术后肛肠动力学指标,观察不同治疗方法对排便功能的影响.方法将113例低位直肠癌ISR患者分为3组,分别为新辅助化疗联合腹腔镜直肠前切除ISR组(A组,n=32):腹腔镜直肠前切除ISR组(B组,n=43):开腹直肠前切除ISR组(C组,n=38),采用肛肠压力监测仪分别检测3组术前、术后3、6、9、12个月肛管动力学、结肠末端动力学、肛管结肠末端动力学相关指标,观察并对比其变化趋势.结果肛管静息压A、B、C组术后3个月[(33.53±6.58)、(24.69 ±5.62)、(14.86±5.54) mm Hg(1 mm Hg =0.133 kPa)]均分别低于术前[(49.37±14.32)、(47.32±7.87)、(46.50±10.02) mm Hg] (P ＜0.05),且A组[(33.53±6.58) mm Hg]比同期B、C组[(24.69±5.62)、(14.86±5.54) mm Hg]降低幅度小(P＜0.05).3组直肠肛管抑制反射阳性率于术后3个月均降低(P＜0.05),且A组比同期B、C组高(P＜0.05).球囊排出试验时间、初始排便容量阈值及最大耐受容量A组均较B组提前3个月恢复至术前水平(P＜0.05),较C组提前6个月恢复至术前水平(P＜0.05).结论新辅助化疗联合腹腔镜直肠前切除对排便动力学影响小.
목적 검측3충불동치료방법하저위직장암경항내외괄약기간절제술(ISR)환자술후항장동역학지표,관찰불동치료방법대배편공능적영향.방법장113례저위직장암ISR환자분위3조,분별위신보조화료연합복강경직장전절제ISR조(A조,n=32):복강경직장전절제ISR조(B조,n=43):개복직장전절제ISR조(C조,n=38),채용항장압력감측의분별검측3조술전、술후3、6、9、12개월항관동역학、결장말단동역학、항관결장말단동역학상관지표,관찰병대비기변화추세.결과 항관정식압A、B、C조술후3개월[(33.53±6.58)、(24.69 ±5.62)、(14.86±5.54) mm Hg(1 mm Hg =0.133 kPa)]균분별저우술전[(49.37±14.32)、(47.32±7.87)、(46.50±10.02) mm Hg] (P ＜0.05),차A조[(33.53±6.58) mm Hg]비동기B、C조[(24.69±5.62)、(14.86±5.54) mm Hg]강저폭도소(P＜0.05).3조직장항관억제반사양성솔우술후3개월균강저(P＜0.05),차A조비동기B、C조고(P＜0.05).구낭배출시험시간、초시배편용량역치급최대내수용량A조균교B조제전3개월회복지술전수평(P＜0.05),교C조제전6개월회복지술전수평(P＜0.05).결론신보조화료연합복강경직장전절제대배편동역학영향소.
Objective To investigate the changes of anorectal dynamics in low rectal carcinomapatients subject to three different kinds of treatments undergoing intersphincteric resection (ISR),evaluatethe clinical effects on anorectal dynamics by three different kinds of treatments,and to discuss the mecha-nisms.Methods 113 low rectal carcinoma patients who received ISR were divided ioto three groups:neo-adjuvant chemotherapy with laparoscopic anterior resection ISR group (group A,n =32),laparoscopic an-terior resection ISR group (group B,n =43 ),open anterior resection ISR group ( group C,n =38 ).Theanorectal dynamics in the three groups was determined and compared before and 3,6,9,12 months afteroperation by an anorectal pressure detector.Results The level of anal resting pressure in the three groupsat 3rd month after operation [(33.53 ± 6.58),(24.69 ± 5.62),( 14.86 ± 5.54) mm Hg ( 1 mm Hg =0.133 kPa)] were remarkably lower than those before operation [(49.37 ± 14.32),(47.32 ± 7.87),(46.50±10.02) mmHg (P＜0.05)],but hada nilder decrease in group A (33.53±6.58) mmHgthan in group B (24.69 ± 5.62) mm Hg and group C (14.86 ± 5.54 )mm Hg ( P ＜ 0.05 ).The positiverate of rectoanal inhibitory reflex at 3rd month after operation was lower significantly than that before opera-tion ( P ＜ 0.05 ),but that in group A was higher than in group B and group C (P ＜ 0.05 ).As comparedwith group B,the levels of balloon-discharge test time,initial defecation capacity threshold and maximumtolerated volume in group A almost recovered to those before operation 3 months ahead of time ( P ＜ 0.05),and as compared with group C,6 months in advance recovery to preoperative levels (P ＜0.05).Conclu-sion Neoadjuvant chemotherapy with laparoscopic anterior resection is appropriate even more for low rectalcarcinoma ISR patients.