30例直肠癌超低位吻合保肛术患者围手术期肛肠测压观察及护理

目的 为了确保ISR手术效果,通过术前、术后对肛肠测压观察,评价超低位直肠癌行括约肌间切除手术(ISR)后的肛门排便功能,探求肛肠测压的方法 及护理.方法 对30例施行ISR手术的超低位直肠癌患者,通过术前、术后对肛肠测压观察、评估肠腔压力情况,术后肛门控便功能,按Williams标准评估肛门排便功能,提供相应的护理.结果 术后30例肛管静息压明显降低(P<0.01),肛门最大收缩压和直肠最大耐受容积较术前均明显降低(P<0.01),随着时间推移逐渐恢复,但不能恢复到术前水平,大部分患者术后肛门直肠抑制反射消失(3/30),且随着时间推移无明显恢复.按Williams的排便自制标准,30例患者术后3个月、6个月、12个月分别有86.7%、93.3%、96.7%的患者达到功能良好效果.结论 术前、术后准确测量直肠肛管静息压,做好测压的护理,并根据静息压情况、对肛门排便功能的评估调整护理措施,利于患者术后肛门排便功能的恢复.

Observation and nursing of anorectal manometry on super-low rectal cancer patients with ISR in perioperative period

Objective To evaluate the defecation function after intersphincter resection (ISR) of super - low rectal cancer and study the nursing methods of anorectal manometry, in order to ensure the effectiveness of ISR. Methods Anorectal rnanometry was used for testing 30 patients with super - low rectal cancer who under ISR before and after operation, After evaluating the pressure of enteric cavity and the rehabilitation of defecation function after operation, relevant nursing was provided according to Williams' standard. Results Anal canal resting pressure was greatly lower after operation (P <0. 01 ) . Maximum squeeze pressure and maximum tolerance of the rectum were greatly reduced ( P < 0. 01 ) and restored gradually in course of time but not to normal. Abolition of rectal anal inhibitory reflex was appeared in most patients after operation (3/30) and restoration of rectal anal inhibitory reflex was not obvious. According to the defecation of Williams'standard, 86.7 %, 93.3 %, 96.7 % of the patients received good effect in defecation function after 3, 6 and 12 month respectively. Conclusions After testing anal canal resting pressure precisely before and after operation and doing well in nursing of the manometry,nursing measures according to the evaluation of resting pressure and defecation function are adjusted. And it is helpful for rehabilitation of defecation function.