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Anorectal Function and Its Influencing Factors in Patients with Mid and Low Rectal Cancer
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摘要:
目的 研究中低位直肠癌患者的肛门直肠功能及其影响因素 目的 2012年9月至2013年11月连续纳入在北京协和医院就诊的中低位直肠癌患者, 填写中低位直肠癌患者排便功能的研究报告表, 并进行三维高分辨肛门直肠压力测定检查。根据肿瘤远侧缘距肛缘的距离将患者分为中位组和低位组 结果 共纳入66例中低位直肠癌患者, 其中男45例, 女21例; 平均年龄(58.86±10.99)岁; 低位组22例, 中位组44例。95.5%患者有便血, 50.0%排便次数增多, 30.3%~40.9%有粪便性状异常、排便急迫感、排便不尽感、里急后重等症状; 便血、排便次数、排便不尽感与肿瘤浸润深度呈正相关(r=0.308, P=0.012;r=0.290, P=0.018;r=0.305, P=0.013)。所有患者的直肠肛门抑制反射均无受损, 持续便意感阈值和最大耐受量均较正常值明显降低; 持续便意感阈值、最大耐受量与肿瘤浸润深度呈负相关(r=-0.333, P=0.007;r=-0.323, P=0.009)。与中位组相比, 低位组患者排便费力发生率高(27.2%比6.8%, P=0.031), 肛门平均静息压低[87.20(49.80)mmHg比108.25(41.80)mmHg, P=0.017] 结论 在中低位直肠癌患者, 除便血外, 排便症状多样化, 且不具有特异性; 中低位直肠癌患者的直肠感觉功能受损明显, 肿瘤浸润深度和肿瘤远侧缘距肛缘的距离不同程度地影响患者肛门直肠感觉和动力功能。 Abstract:Objective To evaluate the anorectal function and its influencing factors in patients with mid and low rectal cancer. Methods Patients diagnosed with mid and low rectal cancer in Peking Union Medical College Hospital from September 2012 to November 2013 were consecutively enrolled in this study. We surveyed the defecation symptoms based on a questionnaire in the face-to-face interview manner and detected the anorectal functions using three-dimensional high-resolution manometry system. The patients were divided into mid and low groups according to the distance from the distal margin of tumor to the anal margin. Results A total of 66 patients were enrolled in this study, including 45 males and 21 females, with a mean age of (58.86±10.99) years. There were 44 patients in the mid group and 22 patients in the low group. Hematochezia was the most commonsymptom (95.5%), frequent bowel movement occurred in 50.0% patients, abnormal bowel forms, urgency, sensation of incomplete defecation, and tenesmus occurred in 30.3%-40.9% of the patients. The occurrences of hematochezia, frequent bowel movement and sensation of incomplete defecation were positively correlated with the depth of tumor infiltration (r=0.308, P=0.012; r=0.290, P=0.018; r=0.305, P=0.013). The rectoanal inhibitory reflex was preserved in all the patients. The volume of constant desire to defecate and the maximum tolerated volume were both lower than the normal references, and both negatively correlated with the depth of tumor infiltration (r=-0.333, P=0.007; r=-0.323, P=0.009). Compared with the mid group, the low group had a higher percentage of patients with difficulties to defecate (27.2% vs. 6.8%, P=0.031), and a significantly lower mean anal resting pressure[87.20(49.80)mmHg vs. 108.25(41.80)mmHg, P=0.017]. Conclusions Mid and low rectal cancer patients manifest with various bowel symptoms with no specificity, except for hematochezia. Patients with mid and low rectal cancer have obviously impaired rectal sensory function. Their anorectal sensory and dynamic functions are influenced by the depth of tumor infiltration and distance from the distal margin of tumor to anal margin. -
表 1 66例中低位直肠癌患者的一般资料
组别 男:女 年龄(x±s, 岁) 体重指数
[M(QR), kg/m2]结肠息肉
[例(%)]肿瘤T分期
(T1:T2:T3:T4)肿瘤家族史
[例(%)]低位组(n=22) 18:4 58.55±11.08 23.69(5.53) 14(63.6%) 3:8:11:0 3(13.6%) 中位组(n=44) 27:17 59.02±11.06 23.24(2.63) 15(34.1%) 2:9:30:3 10(22.7%) 总计(n=66) 45:21 58.86±10.99 23.44(3.05) 29(43.6%) 5:17:41:3 13(19.7%) P值 0.093 0.869 0.430 0.023* 0.024* 0.584 低位组和中位组比较，* P＜0.05 
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表 2 中低位直肠癌患者的排便症状
组别 排便次数(次/d) 排便次数增多 粪便性状异常 便血 排便急迫感 肛门下坠感 肛门直肠疼痛 排便费力 肛门直肠堵塞感 排便不尽感 里急后重 低位组(n=22) 3.0(4.0) 10(45.5%) 6(27.2%) 20(90.9%) 8(36.4%) 3(13.6%) 1(4.5%) 6(27.2%) 3(13.6%) 11(50.0%) 10(45.5%) 中位组(n=44) 4.0(4.0) 23(52.3%) 14(31.8%) 43(97.7%) 13(29.5%) 11(25.0%) 1(2.2%) 3(6.8%) 2(4.5%) 16(36.4%) 12(27.2%) 总计(n=66) 3.0(4.0) 33(50.0%) 20(30.3%) 63(95.5%) 21(31.8%) 14(21.2%) 2(3.0%) 9(13.6%) 5(7.5%) 27(40.9%) 22(33.3%) P值 0.416 0.602 0.705 0.531 0.575 0.456 1.000 0.031* 0.411 0.288 0.140 除排便次数为中位数(四分位间距)外，其他数据为例数(百分比)；低位组和中位组比较，* P＜0.05
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表 3 中低位直肠癌患者肛门直肠压力测定指标[(x±s) /M(QR)]
组别 肛门括约肌高压带
长度(cm)肛门平均静息压
(mmHg)肛门最大缩榨压
(mmHg)初始感觉阈值
(ml)持续便意感阈值
(ml)最大耐受量
(ml)低位组(n=22) 3.45±0.90 87.20(49.80) 253.30±85.89 40.00(20.00) 70.00(33.00) 130.00(83.00) 中位组(n=44) 3.70±0.58 108.25(41.80) 248.30±74.00 30.00(30.00) 50.00(40.00) 120.00(70.00) 总计(n=66) 3.62±0.70 104.90(39.05) 249.96±77.53 30.00(30.00) 50.00(40.00) 120.00(70.00) P值 0.183 0.017* 0.807 0.334 0.281 0.547 1 mmHg=0.133 kPa；低位组和中位组比较，* P＜0.05
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