低位直肠癌患者外科治疗后肛门功能的相关因素研究

目的探讨低位直肠癌患者外科治疗后肛门功能情况及其影响因素。方法回顾性分析2012年1月1日至2014年12月31日进行经腹括约肌间切除(ISR)术的86例低位直肠癌患者临床资料和随访资料。采用统计学软件SPSS17.0进行分析,手术前后对患者直肠肛管压力、抑制反射以及容量等指标采用t检验、计数资料采用卡方(χ~2)检验,采用logistic单因素和多因素分析患者术后肛门功能的影响因素。以P0.05表示差异具有显著性。结果术后患者的平均静息压、最大静息压、肛管缩榨压指标较术前变化不明显。术后患者排便的初始欲望、强烈欲望指标较术前均明显降低,直肠抑制反射阳性患者明显减少(检验值分别为:2.473、2.456、12.762,P0.05)。单因素分析显示,患者的排粪失禁情况与其肿瘤与肛缘之间距离、吻合口与肛缘之间距离以及进行新辅助化疗有关。多因素分析显示,影响肛门排粪失禁情况的独立危险因素包括吻合口与肛缘之间距离低于2 cm、肿瘤距肛缘的距离低于5 cm以及患者进行新辅助放化疗。结论影响低位直肠癌患者外科治疗后肛门功能独立危险因素包括:吻合口与肛缘之间距离低于2 cm、肿瘤距肛缘的距离低于5 cm以及患者进行新辅助放化疗。

Factors relating to anal function of patients who underwent surgery for lower colorectal cancer

Objective To explore the possible factors relating to anal function of patients who received surgical treatment for colorectal cancer . Methods Clinical and follow-up data of 86 patients who underwent transabdominal intersphincteric resection for lower colorectal cancer from 1 January 2012 to 31 December 2014 in our hospital were analyzed retrospectively .Anorectal pressure , suppressive reflection , volume and other indicators in these patients were measured before and after surgery .Patients ’ defecation incontinence was evaluated by using Wexner , and postoperative anal function was assessed by univariate and multivariate analyses . Results Average resting pressure , maximum resting pressure and other indicators 3 months after surgery were significantly lower than those before surgery .The maximum tolerated-dose 9 months after surgery increased more significantly than that before surgery , and the number of RAIN-posi-tive patients was significantly fewer than that after surgery ( relative values were 2.473, 2.456 and 12.762) (P <0.05).Univariate analysis showed that defecation incontinence circumstances were related to the distance between the tumor and anus and the distance between the anastomosis and neoadjuvant chemotherapynus , but it was not related to the age , body mass index and other factors .Multivariate analysis showed that the risk factors for anal defecation incontinence included the distance between the tumor and anus ( <5 cm), the distance between the stoma and anus ( <2 cm) and whether the patients received neoadjuvant chemotherapy after surgery . Conclusion The risk factors for the anal function of patients who received surgical treatment for lower colorectal cancer included: the distance between the tumor and anus (<5 cm ) , the distance between the stoma and anus ( <2 cm ) , and whether the patients received neoadjuvant chemotherapy after surgery .