低位直肠癌经腹括约肌间切除术后患者肛门功能的影响因素分析

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。

Risk factors of anal function after transabdominal intersphincteric resection for low rectal cancer

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.