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目的探讨直肠癌根治术患者排便与残余肛肠动力及血浆相关胃肠激素的关系。方法直肠癌患者行根治术后,根据术式的不同分组,即直肠癌前切除术(Dixson)组及Miles术组。分别检测患者术后不同时期肛肠压力、血浆相关胃肠激素-血浆血管活性肠肽(VIP)、胃动素(MTL),同时设正常对照20例与直肠癌前切除术组对照。Miles术组自身对照。结果(1)Dixson组显示:肛门内括约肌静息压(IAS P)、肛门外括约肌静息压(EAS P)、最大缩窄压(MSP)、直肠感知阈值(RVST)、直肠最大耐受量(MTV)、直肠肛门抑制反射直肠扩张最小充气量(RCR MP)均降低,以术后1～3月明显,随时间推移逐渐升高,半年后略有恢复;此变化与对照组比较有显著性差异,P<0.05。各组VIP皆有不同程度升高,MTL无明显变化。直线相关分析,VIP与RVST值呈正相关,r=0.371P<0.05。与MSP呈负相关,r=-0.583P<0.05。(2)Miles组显示:术后1月及6月相比,结肠的长、短收缩波平均波幅减少,收缩频率变慢,持续时间明显延长,差异有显著性(P<0.05)。簇状收缩波平均波幅无明显改变,但持续时间明显缩短,差异有非常显著性(P<0.01)。结肠长、短收缩波的周期及平均波幅与VIP、MTL无关,r分别在0.42～0.46,0.37～0.41范围,P>0.05。簇状收缩波的持续时间与VIP呈负相关r=-0.34,P<0.05。结论Dixson?
Objective To investigate the relationship between defecation and residual anorectal motility and plasma-associated gastrointestinal hormones in patients undergoing radical resection of rectal cancer. Methods After radical mastectomy, patients with rectal cancer were divided into groups according to different surgical procedures, namely Dixson group and Miles group. The levels of anorectal pressure, plasma-associated gastrointestinal hormone-vasoactive intestinal peptide (VIP) and motilin (MTL) were measured at different stages after operation. Meanwhile, 20 cases of normal control group and control group of rectal cancer were included. Miles group self-control. Results (1) The Dixson group showed that IASP, EASP, MSP, RVST, maximal rectal capacity (MTV), rectum anorectal reflex rectum expansion minimum inflatable capacity (RCR MP) were reduced to 1 to 3 months after surgery, gradually increased over time, a slight recovery after 6 months; this change was significant compared with the control group Sex differences, P <0.05. Each group has increased in varying degrees VIP, MTL no significant change. Linear correlation analysis, VIP and RVST values were positively correlated, r = 0.371P <0.05. Negatively correlated with MSP, r = -0.583P <0.05. (2) The Miles group showed that the average amplitude of long and short contraction wave of colon decreased, the frequency of contraction slowed down and the duration was significantly longer than that of 1 month and 6 months after operation (P <0.05). The average amplitude of cluster contraction wave did not change significantly, but the duration was significantly shortened, the difference was significant (P <0.01). The length and average amplitude of long and short contraction wave of colon were independent of VIP and MTL, r were respectively in the range of 0.42 ~ 0.46 and 0.37 ~ 0.41 (P> 0.05). The duration of cluster contraction wave was negatively correlated with VIP (r = -0.34, P <0.05). Conclusion Dixson?