Chen Ssu-Chi, Futaba Kaori, Leung Wing Wa, Wong Cherry, Mak Tony, Ng Simon, Gregersen Hans
Department of Surgery, the Chinese University of Hong Kong, Shatin, Hong Kong.
California Medical Innovations Institute, San Diego, CA, USA.
Neurogastroenterol Motil. 2022 Mar;34(3):e14208. doi: 10.1111/nmo.14208. Epub 2021 Jun 18.
Most patients who have undergone low anterior resection suffer from bowel dysfunction postoperatively. This condition is referred to as low anterior resection syndrome (LARS). The aim was to study defecatory patterns in LARS patients compared to a primary control group of fecal incontinence (FI) patients and normal subjects (NS) with the Fecobionics device.
Fecobionics expulsion parameters were assessed in an interventional study design. The Fecobionics probe contained pressure sensors at the front, rear, and inside the bag. The bag was distended until urge sensation in rectum in 11 LARS patients (5F/6M, 63.2 ± 2.9 years), 11 FI subjects (7F/4M, 64.4 ± 2.5 years), and 11 NS (7F/4M, 63.6 ± 3.0 years). Defecation indices were computed from the Fecobionics data. All subjects had high-resolution anorectal manometry (ARM) and balloon expulsion test (BET) done. Symptoms were evaluated with LARS and Wexner scores.
The LARS score in the LARS patients was 39.0 ± 0.6. The Wexner score in the LARS, FI, and NS groups was 14.2 ± 0.7, 10.1±1.0, and 0.0 ± 0.0 (p < 0.01). The resting anal pressure and squeeze pressure were lowest in LARS patients (p < 0.05). The urge volume was 11.8 ± 4.2, 59.6 ± 6.4, and 41.6 ± 6.4 ml in the LARS, FI, and NS groups, respectively (p < 0.001). The expulsion duration did not differ between groups. Defecation indices were lowest in the LARS patients (p < 0.05). ARM-BET confirmed the low urge volume in LARS patients whereas anal pressures did not differ between groups.
The LARS patients had low anal pressures and urge volume. Most Defecation Indices differed between the LARS group and the other groups.
大多数接受低位前切除术的患者术后会出现肠道功能障碍。这种情况被称为低位前切除综合征（LARS）。本研究旨在使用Fecobionics设备，对比LARS患者与粪便失禁（FI）患者及正常受试者（NS）这一主要对照组的排便模式。
在一项干预性研究设计中评估Fecobionics排出参数。Fecobionics探头在袋子的前部、后部和内部均装有压力传感器。对11例LARS患者（5例女性/6例男性，63.2±2.9岁）、11例FI受试者（7例女性/4例男性，64.4±2.5岁）和11例NS（7例女性/4例男性，63.6±3.0岁）进行直肠扩张直至产生便意。根据Fecobionics数据计算排便指数。所有受试者均进行了高分辨率肛门直肠测压（ARM）和气囊排出试验（BET）。使用LARS和韦克斯纳评分对症状进行评估。
LARS患者的LARS评分为39.0±0.6。LARS、FI和NS组的韦克斯纳评分分别为14.2±0.7、10.1±1.0和0.0±0.0（p<0.01）。LARS患者的静息肛门压力和挤压压力最低（p<0.05）。LARS、FI和NS组的便意容量分别为11.8±4.2、59.6±6.4和41.6±6.4ml（p<0.00１）。各组间排出持续时间无差异。LARS患者的排便指数最低（p<0.05）。ARM-BET证实LARS患者的便意容量较低，而各组间肛门压力无差异。
LARS患者的肛门压力和便意容量较低。LARS组与其他组之间的大多数排便指数存在差异。
