低位直肠癌前切除术后肛门直肠功能研究进展

低位直肠癌前切除术 全系膜切除(totalmesorectalexcision,TME) 保留植物神经(autonomicnervepreservation,ANP)已成为外科治疗低位直肠癌的常规术式,低位直肠癌的外科治疗越来越倾向于在彻底切除肿瘤的前提下尽量保留肛门,但保留肛门后患者肛门直肠功能常常并不令人满意。许多学者从肛肠动力学角度探讨了前切除术后综合征的发生机制及改善前切除术后肛门直肠功能的方法。前切除术后综合征的发生与新建直肠的容量、顺应性改变、肛门内外括约肌功能损伤内括约肌神经反射通路损伤、及排便感觉等病理生理机制有关。针对以上前切除术后的病理生理改变,许多学者提出了一系列方法来改善前切除术后的肛门直肠功能,包括术中保留植物神经、保留耻骨直肠肌及肛门直肠角重建以及增加新建直肠的容量。目前的研究表明,通过手术方式的改进在一定程度上可改善直肠前切除术后肛门直肠功能。

Development in research on anorectal function after lower rectal cancer anterior resection

Lower rectal anterior resection(LAR) total mesorectal excisision (TME) autonomic nerve preservation(ANP) has become a standard procedure for lower rectal cancer. Most patients treated by traditional LAR complain of postoperative stool excretion dysfunction. Both pathophysiology mechanisms of post anterior resection syndrome and methods to improve anorectal function after anterior resection have been advocated according to anorectal dynamics. Explanations for impaired anorectal function include impaired neorectal capacity or compliance, decreased internal and external anal sphincter function due to direct damage or injury of the nervous supply, and the loss of rectal sensation. Methods to improve anorectal function after anterior resection include autonomic nerve preservation, puborectalis muscle preservation and anorectal angle restruction, etc. At present, many studies show it is feasible to improve anorectal function after anterior resection by surgical technique.