Study On The Changes Of Anal Function After Anal Sphincter Preservation For Ultra-low Rectal Cancer

Abstract A controlled study of the retention and recovery of bowel habits and anal sphincter function before and after surgery in patients with ultra-low rectal cancer anus-preserving surgery,to investigate the retention and recovery of anal function in patients with ultra-low rectal cancer after anal sphincter preservation,and to provide evidence for treatment strategies and treatment methods for patients with ultra-low rectal cancer.Methods:Between January 2012 and January 2016,patients with ultra-low rectal cancer anus-preserving surgery(ISR?Dixon)in our hospital(Hunan Provincial People's Hospital)were selected.The anastomotic position was<3 cm from the anal margin,and the rectal examination and hard rectaloscopy were used.34 patients with ultra-low rectal cancer(including 21 males and 13 females)were enrolled in the experimental group.At the same time,20 patients with colon cancer surgery were established as a control group.Subjective and objective aspects were compared to evaluate the anal function of the two groups before and after surgery.The objective evaluation index was the maximum anal canal resting pressure,the average anal canal resting pressure,the rectal inhibition reflex positive rate,and the maximum anal canal compression pressure collected in the anorectal manometry.The patients were examined before surgery,3 months after surgery,6 months after surgery,1 year after surgery,1 year and a half after surgery,2 years after surgery,and 3 years after surgery.The subjective evaluation index was based on Xu Zhongfa's“5-point 10-point system”anal function assessment questionnaire,which included 5 indicators including convenience,sensory function,control ability,defecation time,and number of bowel movements.The scores were divided into four categories:excellent,good,average,and poor.Finally,statistical analysis was carried out to compare the changes of the indexes of the nodes before,after and after the operation.The measurement data of anorectal manometry were expressed as mean±standard deviation,using t test.The grading index was expressed as the rate of use.Using the X ~2 test,P<0.05 was selected as the standard for statistical difference.All data were analyzed using SPSS 25.0 software statistics.Result:Anorectal manometry:1.There is no statistically significant difference between the experimental group and the control group before the operation,the average resting pressure of the anal canal,the maximum resting pressure of the anal canal,the maximum contraction pressure of the anal canal,and the rectal anal suppression reflex(p>0.05);2.In the experimental group,the average resting pressure of the anal canal,the maximum resting pressure of the anal canal,the maximum contraction pressure of the anal canal,and the positive rate of rectal inhibition were still significantly lower than those before the operation(p<0.05).3.In the experimental group,the maximum contraction pressure of the anal canal reached the preoperative level at 1 year after operation(p>0.05);4.the average anal canal resting pressure and the maximum rest of the anal canal in the experimental group at 3 years after operation The pressure had not reached the preoperative level(p<0.05).5.The subjective and objective evaluation indexes of the control group were close to the preoperative level at 3 months after operation(p>0.05).6.One patient did not elicit RAIR at 3 months after surgery,and the positive rate of rectal analectal reflex was significantly increased in the experimental group at 3years after surgery.However,the preoperative level was not reached after3 years of operation(p<0.05).Xu Zhongfa's subjective assessment of anal function:3 months,6 months,1 year,1 year and a half,2 years,3 years after surgery.Questionnaire analysis and analysis:1.The excellent rate of the experimental group was statistically different from the control group at 3 months,6 months,1 year,1 year and a half,2 years after surgery.There was no statistical analysis after 3 years difference(P>0.05).Conclusion:In patients with ultra-low rectal cancer who underwent anal sphincter surgery,after 3 years of recovery and anal function training,most patients can maintain normal anal function,and a small number of patients failed to return to preoperative levels,but there is a tendency to gradually recover.Ultra-low rectal cancer anus-preserving surgery is safe and reliable for the protection of anal function,which is worthy of clinical promotion.