Otto I C, Ito K, Ye C, Hibi K, Kasai Y, Akiyama S, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Dis Colon Rectum. 1996 Dec;39(12):1423-7. doi: 10.1007/BF02054533.
Low anterior resection (LAR) is the treatment of choice for middle and high rectal tumors. Even though the rectal sphincter is preserved, some patients show a postoperative loss of rectal continence that may be recovered during follow-up. The purpose of this study was to collect clinical and manometric data before and after LAR to find possible explanations for incontinence.
Seventeen continent patients with rectal tumors located 10 cm above the anal verge were selected. Manometry was performed before and three months after surgery and when stable frequency of bowel movement was achieved (mean, 7 months).
Immediately after the operations, 14 of 17 patients showed a certain degree of incontinence but recovered during follow-up; at the end of the study, only two patients reported minor soiling. Resting and squeeze pressures were moderately reduced after surgery and increased during the following six months without regaining preoperative levels. Rectoanal inhibitory reflex was present in 94.4 percent of patients before the operations and in 25 percent of them after surgery, but it was not associated with incontinence. Rectal sensation was significantly reduced, and its recovery was well correlated with decrease in the frequency of bowel movements.
After LAR, there is a reduction in rectal pressures, suggesting damage to sphincter muscle fibers or innervation. There is also a reduction in rectal sensation related to loss in reservoir capacity, all of which may contribute to incontinence.
低位前切除术（LAR）是中高位直肠肿瘤的首选治疗方法。尽管保留了直肠括约肌，但一些患者术后仍出现直肠控便能力丧失，不过在随访期间可能会恢复。本研究的目的是收集低位前切除术前和术后的临床及测压数据，以寻找失禁的可能原因。
选择17例肛管齿状线以上10 cm处患有直肠肿瘤且控便功能正常的患者。在手术前、术后3个月以及排便频率稳定时（平均7个月）进行测压。
术后即刻，17例患者中有14例出现了一定程度的失禁，但在随访期间恢复；在研究结束时，只有2例患者报告有轻微便污。术后静息压和挤压压适度降低，在随后的6个月内有所升高，但未恢复到术前水平。术前94.4%的患者存在直肠肛管抑制反射，术后这一比例为25%，但其与失禁无关。直肠感觉明显降低，其恢复与排便频率的降低密切相关。
低位前切除术后，直肠压力降低，提示括约肌肌纤维或神经支配受损。与贮便能力丧失相关的直肠感觉也降低，所有这些都可能导致失禁。
