【作者】 李雪；

【导师】 王磊；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 目的:将术中保护性回肠造口与术后生物反馈治疗联合应用于行腹腔镜经括约肌间切除术(p ISR)的低位直肠癌患者,通过对比术后肛门功能评估该方法的有效性,以探索有效的防止低位直肠癌术后肛门功能障碍的措施。方法:本研究选取自2019年6月至2021年10月期间,128例于我院接受腹腔镜经括约肌间切除术(p ISR)手术的低位直肠癌患者,根据纳入与排除标准,最终纳入40例患者,在病情和患者及家属意愿允许的前提下,随机分为四组,即:A组(p ISR组)、B组(p ISR+术后生物反馈治疗组)、C组(p ISR+保护性回肠造口组)、D组(p ISR+保护性回肠造口+术后生物反馈治疗组)。患者一般资料比较无统计学差异(P>0.05),具有可比性。分别于p ISR术后6个月、15个月(即C组、D组回肠造口还纳术后3个月、12个月)通过直肠肛管测压、LARS评分、Wexner失禁评分、VAS评分评价肛门功能,通过单因素方差分析验证实验方法的有效性。结果:方差分析结果显示,A组、B组、C组、D组术后6个月、15个月直肠肛管测压、LARS评分、WIS评分、VAS评分差异均无统计学意义(P>0.05),多重比较结果显示,D组术后6个月、15个月的直肠肛管测压、LARS评分、WIS评分、VAS评分均明显优于A组,差异有统计学意义(P<0.05),B组术后6个月、15个月RRP明显优于A组,差异有统计学意义(P<0.05),其余组间比较未见明显差异(P>0.05)。结论:保护性回肠造口可在一定程度上减少p ISR术后并发症的发生,有利于患者术后短期康复,生物反馈治疗有利于肛门功能恢复,两项技术单独应用于p ISR术后患者中,肛门功能改善不显著,二者联合应用可减轻p ISR术后肛门功能障碍,在一些存在高危因素的患者中值得使用推广。更多还原

【Abstract】 Objective:The combination of intraoperative protective ileostomy and postoperative biofeedback therapy was applied in patients with low rectal cancer undergoing laparoscopic transsphincterectomy(p ISR).The effectiveness of this method was evaluated by comparing postoperative anal function,so as to explore effective measures to prevent anal dysfunction after low rectal cancer surgery.Methods:In this study,128 patients with low rectal cancer who received laparoscopic transsphincterectomy(p ISR)in our hospital from June 2019 to October 2021 were selected.According to the inclusion and exclusion criteria,40 patients were eventually included and randomly divided into four groups as long as the condition and the willingness of patients and their families allowed,namely: Group A(p ISR group),Group B(p ISR+ postoperative biofeedback therapy group),group C(p ISR+protective ileostomy group),and group D(p ISR+ protective ileostomy +postoperative biofeedback therapy group).There was no statistical difference in the general data of patients(P>0.05),which was comparable.Anal function was evaluated by anorectal manometry,LARS score,Wexner incontinence score and VAS score at 6months and 15 months after p ISR(i3 months and 12 months after ileostomy reduction in groups C and D),and the effectiveness of the experimental method was verified by one-way analysis of variance.Results:The results of variance analysis showed that there were no significant differences in anorectal manometry,LARS score,WIS score and VAS score in groups A,B,C and D at 6 months and 15 months after surgery(P > 0.05).Multiple comparison results showed that,Anorectal manometry,LARS score,WIS score and VAS score of group D at 6 months and 15 months after operation were significantly better than those of group A,and the differences were statistically significant(P<0.05),the RRP of group B at 6 months and 15 months after operation was significantly better than that of group A,the difference was statistically significant(P<0.05),there was no significant difference among the other groups(P > 0.05).Conclusion:Protective ileostomy can reduce the occurrence of complications after p ISR to a certain extent,which is conducive to the short-term postoperative rehabilitation of patients,and biofeedback therapy is conducive to the recovery of anal function.The two technologies applied to patients after p ISR surgery alone,the improvement of anal function is not significant,and the combined application of the two technologies can alleviate the anal dysfunction after p ISR surgery.It is worth using and promoting in some patients with high risk factors.更多还原