CAJ | 학술논문

目的：探讨经腹括约肌间切除（ISR）术后肛门功能情况及其影响因素。方法回顾性分析2005年1月至2012年12月福建医科大学附属协和医院结直肠外科同一组医师实施经腹ISR治疗的96例低位直肠癌患者临床和随访资料。采用Wexner排粪失禁评分评估肛门功能，并通过Cox比例风险模型分析肛门功能的影响因素。结果96例经腹ISR患者均完成Wexner评分量表的评估，平均随访时间32．7月，其中83例（86．5％）排粪控制良好（Wexner评分小于10分）。Wexner评分与术后随访时间呈线性负相关（r＝-0．078，P＝0．003）。单因素分析显示，肿瘤距肛缘距离（P＝0．043）、吻合口距肛缘（P＝0．001）及新辅助放化疗（P＝0．001）与术后肛门失禁有关。多因素分析显示，吻合口距肛缘小于2 cm（P＝0．020）和新辅助放化疗（P＝0．001）是经腹ISR术后排粪失禁的独立危险因素。结论经腹ISR术后多数患者肛门功能良好，吻合口距肛缘不足2 cm和新辅助放化疗是影响术后肛门功能的独立危险因素。
목적：탐토경복괄약기간절제（ISR）술후항문공능정황급기영향인소。방법회고성분석2005년1월지2012년12월복건의과대학부속협화의원결직장외과동일조의사실시경복ISR치료적96례저위직장암환자림상화수방자료。채용Wexner배분실금평분평고항문공능，병통과Cox비례풍험모형분석항문공능적영향인소。결과96례경복ISR환자균완성Wexner평분량표적평고，평균수방시간32．7월，기중83례（86．5％）배분공제량호（Wexner평분소우10분）。Wexner평분여술후수방시간정선성부상관（r＝-0．078，P＝0．003）。단인소분석현시，종류거항연거리（P＝0．043）、문합구거항연（P＝0．001）급신보조방화료（P＝0．001）여술후항문실금유관。다인소분석현시，문합구거항연소우2 cm（P＝0．020）화신보조방화료（P＝0．001）시경복ISR술후배분실금적독립위험인소。결론경복ISR술후다수환자항문공능량호，문합구거항연불족2 cm화신보조방화료시영향술후항문공능적독립위험인소。
Objective To explore the risk factors of anal function after transabdominal intersphincteric resection (ISR) for low rectal cancer. Methods Clinical and follow-up data of 96 patients with low rectal cancer who underwent transabdominal ISR in our department from January 2005 to December 2012 were analyzed retrospectively. The Wexner scoring scale was used to evaluate the anal function and the risk factors of anal function were analyzed by the C ox proportional hazard model. Results Ninety-six patients completed Wexner scoring scale with mean follow-up of 32.7 months. Eighty-three cases (86.5%) presented good continence with a Wexner score less than 10. There was negative correlation between Wexner score and follow-up duration (Pearson coefficient, -0.078, P=0.003). Univariate analysis suggested the distance less than 5 cm from tumor to anal verge (P=0.043), height less than 2 cm from anastomosis to anal verge (P=0.001) and neoadjuvant chemoradiotherapy (P=0.001) were the risk factors. Multivariate analysis revealed that distance less than 2 cm from anastomosis to anal verge (P=0.020) and neoadjuvant chemoradiotherapy (P=0.001) were independent risk factors for fecal incontinence. Conclusions Most patients have good continence after transabdominal ISR. A distance of less than 2 cm from anastomosis to anal verge and neoadjuvant chemoradiotherapy are independent risk factors for poor anal function after transabdominal ISR.