直肠癌保肛术后排便功能障碍的研究进展
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摘要
直肠癌的发病率目前呈逐年升高趋势,我国结直肠发病率每年更以3.33%的速度递增,远高于世界平均水平,该病严重危害患者的身体健康和生命安全,其防治形势十分严峻。近年来,我国医疗卫生水平不断提高,保留肛门的手术标准不断完善,经腹直肠癌切除术(Dixon手术)可彻底清扫病灶及受侵组织,并且可保留肛门,其在临床上的应用十分广泛。一般而言,在结肠癌保肛手术之后的排便问题一直是影响患者的重要问题,主要是术后患者的括约肌以及部位神经等遭受损伤,进而引起的功能障碍。基于此,本文对直肠癌患者术后排便功能障碍发生的机制以及防治手段等展开研究。
The incidence of rectal cancer is increasing year by year,the incidence of colorectal cancer in China each year to 3.33% rate of increase,much higher than the world average,the disease seriously endanger the health and safety of patients,the prevention and control situation is very grim.In recent years,China's health care standards continue to improve,continue to improve the standard of anus preserving operation,transabdominal resection of rectal cancer(Dixon operation) can thoroughly clean the lesion and the invaded tissues,and can keep the anus,its clinical application is very extensive.Generally speaking,defecation after colon cancer surgery has been an important problem affecting the patient,mainly after the patient's sphincter and part of the nerve damage,resulting in dysfunction.Based on this,this paper studies the mechanism and prevention measures of postoperative defecation dysfunction in patients with rectal cancer.
The incidence of rectal cancer is increasing year by year,the incidence of colorectal cancer in China each year to 3.33% rate of increase,much higher than the world average,the disease seriously endanger the health and safety of patients,the prevention and control situation is very grim.In recent years,China's health care standards continue to improve,continue to improve the standard of anus preserving operation,transabdominal resection of rectal cancer(Dixon operation) can thoroughly clean the lesion and the invaded tissues,and can keep the anus,its clinical application is very extensive.Generally speaking,defecation after colon cancer surgery has been an important problem affecting the patient,mainly after the patient's sphincter and part of the nerve damage,resulting in dysfunction.Based on this,this paper studies the mechanism and prevention measures of postoperative defecation dysfunction in patients with rectal cancer.
引文
[1]梁雪亭,王千心,孙田杰,等.高龄低位直肠癌保肛手术后患者排便功能训练的研究[J].中国医科大学学报,2014,43(6):512-514.
[2]Fujii S,Ishibe A,Ota M,et al.Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients[J].Surg Endosc,2014,28(2):466-476.
[3]黄志养,金捷,黄智铭,等.低位直肠癌保肛术后排便功能及生活质量状况的临床研究[J].中国基层医药,2016,23(4):568-572.
[4]高明,李鹏,韩方海.低位直肠癌保肛手术方式的临床效果及生活质量比较[J].中国综合临床,2014,30(4):416-418.
[5]曹益晟,余永明,戴晓宇,等.直肠癌前切除术后患者肛门直肠功能变化的研究[J].现代实用医学,2015,27(3):356-358.
[6]李冬,王懿,郭彤阳,等.中低位直肠癌患者低位前切除术对肛门直肠功能影响研究[J].临床与病理杂志,2016,36(9):1356-1359.
[7]皮艳娜,肖毅,王智凤,等.中低位直肠癌患者的肛门直肠功能及其影响因素[J].协和医学杂志,2015,6(2):97-101.
[8]Scabini S,Rimini E,Romairone E,et al.Retraction:colon and reetal surgery for cancer without mechanical bowel preparation:one center randomized prospective trial[J].World J Surg On-col,2014,10(1):196.
[9]Loos M,Quentmeier P,Schuster T,et al.Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients:a systematic review and meta-analysis[J].Ann Surg Oncol,2013,20(6):1816-1828.
[10]吴欣,匡荣康,蒋勇敢,等.Miles术与Dixon术对老年直肠癌的疗效观察[J].中国肿瘤外科杂志,2014,6(3):195-197.
[11]侯晓婷,庞冬,路潜,等.直肠癌保肛术后患者肠道功能的现况调查[J].中华护理杂志,2015,50(12):1438-1443.
[12]肖萍.完全腹腔镜下低位直肠癌Dixon术30例围术期护理及体会[J].中国保健营养(上旬刊),2013,23(6):2810-2811.
[13]Denost Q,Adam J P,Pontallier A,et al.Laparoscopic total meso-rectal excision with coloanal anastomosis for rectal cancer[J].Ann Surg,2015,261(1):138-143.
[14]Muratore A,Mellano A,Marsanic P,et al.Transanal total meso-rectal excision(ta TME)for cancer located in the lower rectum:short-and mid-term results[J].Eur J Surg Oncol,2015,41(4):478-483.
[15]Kwoun H J,Shin Y H.Impact of Bowel Function,Anxiety and Depression on Quality of Life in Patients with Sphincterpreserving Resection for Rectal Cancer[J].J Korean Acad Nur,2015,45(5):733-741.
[16]麦建全,杨景先,庄潮平,等.内括约肌部分切除低位直肠癌超低位吻合保肛术的临床分析[J].实用医学杂志,2015,31(12):1960-1962.
[17]Bregendahl S,Emmertsen K J,Lous J,et al.Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer:a population-based cross-sectional study[J].Colorectal Dis,2013,15(9):1130-1139.
[18]Mehrvarz S,Towliat S M,Mohebbi H A,et al.Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection[J].Iran Red Crescent Med J,2013,15(1):32-35.
[19]Scheer A S,Boushey R P,Liang S,et al.The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer:a systematic review and meta-analysis[J].Dis Colon Rectum,2011,54(12):1589-1597.
[20]Taylor C,Bradshaw E.Tied to the toilet:lived experiences of altered bowel function(anterior resection syndrome)after temporary stoma reversal[J].J Wound Ostomy Continence Nurs,2013,40(4):415-421.
[21]Chen T Y,Emmertsen K J,Laurberg S.What Are the Best Questionnaires To Capture Anorectal Function After Surgery in Rectal Cancer[J].Current Colorectal Cancer Reports,2015,11(1):37-43.
[22]苏连菊.综合护理干预在Dixon术治疗低位直肠癌患者围术期护理中的应用效果[J].国际护理学杂志,2016,35(8):1053-1055.
[23]王留针.延续性护理对低位保肛直肠癌患者术后排便功能及生活质量的影响[J].国际护理学杂志,2017,36(2):186-188.
[24]Ihn M H,Kang S B,Kim D W,et al.Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery:a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument[J].Dis Colon Rectum,2014,57(8):958-966.
[25]潘燕,俞一峰,龚海,等.提肛运动对于直肠癌保肛术后肛门功能恢复的疗效观察[J].医学综述,2012,18(17):2927-2928.
[26]王庆香.生物反馈训练在中低位直肠癌保肛术后大便失禁患者的临床疗效及护理对策[J].国际护理学杂志,2016,35(2):280-282.
[27]高恒清,印丽华,应征.隔姜灸联合腹部熨烫促进直肠癌保肛术后胃肠道功能恢复的临床研究[J].中国烧伤创疡杂志,2014,26(5):371-374.
[2]Fujii S,Ishibe A,Ota M,et al.Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients[J].Surg Endosc,2014,28(2):466-476.
[3]黄志养,金捷,黄智铭,等.低位直肠癌保肛术后排便功能及生活质量状况的临床研究[J].中国基层医药,2016,23(4):568-572.
[4]高明,李鹏,韩方海.低位直肠癌保肛手术方式的临床效果及生活质量比较[J].中国综合临床,2014,30(4):416-418.
[5]曹益晟,余永明,戴晓宇,等.直肠癌前切除术后患者肛门直肠功能变化的研究[J].现代实用医学,2015,27(3):356-358.
[6]李冬,王懿,郭彤阳,等.中低位直肠癌患者低位前切除术对肛门直肠功能影响研究[J].临床与病理杂志,2016,36(9):1356-1359.
[7]皮艳娜,肖毅,王智凤,等.中低位直肠癌患者的肛门直肠功能及其影响因素[J].协和医学杂志,2015,6(2):97-101.
[8]Scabini S,Rimini E,Romairone E,et al.Retraction:colon and reetal surgery for cancer without mechanical bowel preparation:one center randomized prospective trial[J].World J Surg On-col,2014,10(1):196.
[9]Loos M,Quentmeier P,Schuster T,et al.Effect of preoperative radio(chemo)therapy on long-term functional outcome in rectal cancer patients:a systematic review and meta-analysis[J].Ann Surg Oncol,2013,20(6):1816-1828.
[10]吴欣,匡荣康,蒋勇敢,等.Miles术与Dixon术对老年直肠癌的疗效观察[J].中国肿瘤外科杂志,2014,6(3):195-197.
[11]侯晓婷,庞冬,路潜,等.直肠癌保肛术后患者肠道功能的现况调查[J].中华护理杂志,2015,50(12):1438-1443.
[12]肖萍.完全腹腔镜下低位直肠癌Dixon术30例围术期护理及体会[J].中国保健营养(上旬刊),2013,23(6):2810-2811.
[13]Denost Q,Adam J P,Pontallier A,et al.Laparoscopic total meso-rectal excision with coloanal anastomosis for rectal cancer[J].Ann Surg,2015,261(1):138-143.
[14]Muratore A,Mellano A,Marsanic P,et al.Transanal total meso-rectal excision(ta TME)for cancer located in the lower rectum:short-and mid-term results[J].Eur J Surg Oncol,2015,41(4):478-483.
[15]Kwoun H J,Shin Y H.Impact of Bowel Function,Anxiety and Depression on Quality of Life in Patients with Sphincterpreserving Resection for Rectal Cancer[J].J Korean Acad Nur,2015,45(5):733-741.
[16]麦建全,杨景先,庄潮平,等.内括约肌部分切除低位直肠癌超低位吻合保肛术的临床分析[J].实用医学杂志,2015,31(12):1960-1962.
[17]Bregendahl S,Emmertsen K J,Lous J,et al.Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer:a population-based cross-sectional study[J].Colorectal Dis,2013,15(9):1130-1139.
[18]Mehrvarz S,Towliat S M,Mohebbi H A,et al.Comparison of Colonic J-pouch and Straight Coloanal anastomosis after Low Anterior Resection[J].Iran Red Crescent Med J,2013,15(1):32-35.
[19]Scheer A S,Boushey R P,Liang S,et al.The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer:a systematic review and meta-analysis[J].Dis Colon Rectum,2011,54(12):1589-1597.
[20]Taylor C,Bradshaw E.Tied to the toilet:lived experiences of altered bowel function(anterior resection syndrome)after temporary stoma reversal[J].J Wound Ostomy Continence Nurs,2013,40(4):415-421.
[21]Chen T Y,Emmertsen K J,Laurberg S.What Are the Best Questionnaires To Capture Anorectal Function After Surgery in Rectal Cancer[J].Current Colorectal Cancer Reports,2015,11(1):37-43.
[22]苏连菊.综合护理干预在Dixon术治疗低位直肠癌患者围术期护理中的应用效果[J].国际护理学杂志,2016,35(8):1053-1055.
[23]王留针.延续性护理对低位保肛直肠癌患者术后排便功能及生活质量的影响[J].国际护理学杂志,2017,36(2):186-188.
[24]Ihn M H,Kang S B,Kim D W,et al.Risk factors for bowel dysfunction after sphincter-preserving rectal cancer surgery:a prospective study using the Memorial Sloan Kettering Cancer Center bowel function instrument[J].Dis Colon Rectum,2014,57(8):958-966.
[25]潘燕,俞一峰,龚海,等.提肛运动对于直肠癌保肛术后肛门功能恢复的疗效观察[J].医学综述,2012,18(17):2927-2928.
[26]王庆香.生物反馈训练在中低位直肠癌保肛术后大便失禁患者的临床疗效及护理对策[J].国际护理学杂志,2016,35(2):280-282.
[27]高恒清,印丽华,应征.隔姜灸联合腹部熨烫促进直肠癌保肛术后胃肠道功能恢复的临床研究[J].中国烧伤创疡杂志,2014,26(5):371-374.