Broens P, Van Limbergen E, Penninckx F, Kerremans R
Department of Abdominal Surgery, University Clinics Gasthuisberg, Catholic University of Leuven, Belgium.
Int J Colorectal Dis. 1998;13(2):68-72. doi: 10.1007/s003840050137.
This study evaluates anorectal function after combined tele- and brachytherapy for anal cancer using manometric measurements and a standardized questionnaire. Eight patients received 44 +/- 3 Gy external beam radiation followed by 20 +/- 4 Gy interstitial brachytherapy with iridium-192. Patients were examined 43 months (range 25-83) after therapy. Maximum anal basal pressure, squeeze pressure, and squeeze increment were significantly lower in patients (50, 163, 115 mmHg, respectively) than in control subjects (75, 285, 180 mmHg, respectively). Decreased anal elasticity was not observed. Anal prestretch "normalized" the contractility of the internal and external sphincter. Thus damage to the anal epithelium and hemorrhoidal cushions seems to be the most important mechanism explaining reduced anal closing pressure values. The rectoanal inhibitory reflex was observed in all but one patient. Rectal compliance was significantly reduced. Whereas all patients could retain a water filled rectal balloon until the maximum tolerable sensation level was reached, the rectal saline infusion test was strongly abnormal. Four patients were perfectly continent. Four patients were incontinent for gas and presented urgency in case of liquid stools with limited soiling occurring once weekly or less; three of them also had urgency for solids. Defecation frequency was increased but regular in most patients. Reduced anal closure together with reduced rectal compliance are at the basis of stool frequency, urgency and partial incontinence with occasional soiling. However, enough reserve sphincter function was maintained to preserve a clinically acceptable degree of anal continence in our patients.
本研究使用测压测量和标准化问卷评估肛管癌患者接受远距离和近距离联合放疗后的肛肠功能。8例患者接受了44±3Gy的外照射，随后用铱-192进行20±4Gy的组织间近距离放疗。在治疗后43个月（范围25 - 83个月）对患者进行检查。患者的最大肛管基础压力、挤压压力和挤压增量（分别为50、163、115mmHg）显著低于对照组（分别为75、285、180mmHg）。未观察到肛管弹性降低。肛管预拉伸使内、外括约肌的收缩力“正常化”。因此，肛管上皮和痔垫的损伤似乎是解释肛管闭合压力值降低的最重要机制。除1例患者外，所有患者均观察到直肠肛管抑制反射。直肠顺应性显著降低。虽然所有患者都能保留充满水的直肠球囊直至达到最大耐受感觉水平，但直肠盐水灌注试验严重异常。4例患者完全控便。4例患者有气体失禁，出现稀便时伴有急迫感，每周弄脏一次或更少；其中3例患者对固体粪便也有急迫感。大多数患者排便频率增加但规律。肛管闭合降低以及直肠顺应性降低是排便频率增加、急迫感和部分失禁伴偶尔弄脏的基础。然而，足够的括约肌储备功能得以维持，使我们的患者保持临床上可接受的肛管节制程度。
