Department of General Surgery, Medipol Mega Hospital, Istanbul Medipol University Medical School, TEM Avruoa Otoyolu Göztepe Çıkışı, No: 1 Bağcılar, 34214, Istanbul, Turkey.
Department of Gastroenterology, Istanbul Medipol University Medical School, Istanbul, Turkey.
Tech Coloproctol. 2024 Aug 14;28(1):109. doi: 10.1007/s10151-024-02989-1.
Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery.
This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection.
Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications.
Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.
直肠癌手术后失禁并不罕见。富含血小板的血浆可能促进组织修复和再生，但从未被用于治疗肛门失禁。本研究评估了直肠低位癌术后注射富含血小板的血浆对内痔外括约肌的影响。
这是一家结直肠肿瘤机构的前瞻性队列概念验证研究。患者接受低位前切除术或内外括约肌间切除术治疗低位直肠癌，Wexner 评分>4 分。在经肛门超声（EAUS）引导下，将 10ml 富含血小板的血浆注入内、外括约肌。主要观察指标为 Wexner 评分改善>2 分（改善组）。采用经肛超声检查、测压、Wexner 问卷和 SF-36 健康调查评估患者，询问患者在 PRP 注射前后是否使用护垫和止泻药。
研究共纳入 20 例患者，其中男 14 例（70%），平均年龄 56.8（SD=9.5）岁。PRP 注射前后 Wexner 评分无统计学差异（p=0.66）。7 例（35%）患者 Wexner 评分改善>2 分。直肠测压显示收缩压改善（p=0.0096）。此外，SF-36 问卷中的生理功能评分（p=0.023）、角色限制（p=0.016）、情感健康（p=0.0057）和社会功能（p=0.043）评分均有所改善。1 例（5%）和 3 例（15%）患者停止使用护垫和止泻药。
富含血小板的血浆注射不能恢复 Wexner 评分，但超过三分之一的患者可能受益于该应用，其评分改善>2 分。富含血小板的血浆注射可能改善直肠癌术后失禁患者的收缩压和某些生活质量指标。
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