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目的探讨肛门括约肌肌电图(EAS-EMG)检测对直肠癌保肛手术患者术后肛门功能评价的意义。方法选择健康志愿者20例及经肠镜检查证实高位、中位、低位直肠癌患者各20例(第一至第四组),其中男性45例,女性35例;年龄31~81岁,平均年龄57.2岁。顺利完成直肠癌保肛根治手术且无严重并发症。术前、术后3个月及12个月进行肛门功能评分和EAS-EMG测定,并定期检查肿瘤免疫指标及胸腹部CT,观察有无肿瘤复发及转移,出现者予以剔除;比较分析各组、各时间点EAS-EMG、肛门功能评分情况及两种评价方法的相关性。结果随访12个月期间,第一组1例肛周感染退出研究,第二组1例、第四组3例肿瘤复发或转移退出研究,第三组2例失访;最终纳入统计共73例,其中第一组19例,第二组19例,第三组18例,第四组17例;所有在研者未出现EAS-EMG相关不良反应。术前运动单位动作电位(MUAP)波幅第二组与第一组、第三组比较,差异有统计学意义(P<0.05);术后3个月MUAP波幅第二组与第三组比较,差异有统计学意义(P<0.05);第四组各时间点肛门功能评分及自发电位出现率、MUAP时限、MUAP波幅、多相波百分比、单纯相出现率、病理干扰相出现率与其他3组比较,差异有显著统计学意义(P<0.01);第四组术后3个月肛门功能评分及MUAP时限、MUAP波幅、多相波百分比与其术前、术后12个月比较,差异有统计学意义(P<0.05)。EAS-EMG各检测指标与徐忠法评分表肛门功能分值呈显著相关性(r=0.31~0.78)。结论 EAS-EMG是一项客观评价直肠癌保肛术后肛门功能的检测手段,其与肛门功能评分有较好的一致性;通过EAS-EMG检测,发现低位直肠癌较易影响肛门神经、肌肉功能,且术后3个月内肛门功能影响明显,12个月有所恢复;对于术前EAS-EMG存在神经源性损害的直肠癌患者,应高度警惕临床下神经侵犯及转移,加强相关检查及随访。
Objective To investigate the significance of anal sphincter electromyography (EAS-EMG) in the evaluation of anal function in patients undergoing anal sphincter preservation surgery. Methods Twenty healthy volunteers (20 males and 35 females, aged 31-81 years) were enrolled in this study. Twenty patients with high, moderate and low rectal cancers confirmed by enteroscopy were enrolled in this study. 57.2 years old. Smooth rectal cancer anorectal surgery without serious complications. Anal function scores and EAS-EMG were measured preoperatively, 3 months and 12 months after operation. Tumor immune parameters and thoracoabdominal and abdominal CT were examined regularly to observe the presence or absence of tumor recurrence and metastasis. , EAS-EMG at each time point, anal function score and the correlation between the two evaluation methods. Results During the follow-up period of 12 months, the first group of patients with perianal infection withdrew from the study, the second group with one case, the fourth group with three cases with tumor recurrence or metastasis, and the third group with two cases without follow-up. Finally, a total of 73 cases , Of which 19 cases in the first group, 19 cases in the second group, 18 cases in the third group and 17 cases in the fourth group. All the EAS-EMG-related adverse reactions did not occur in all the investigators. There was significant difference between the amplitude of MUAP in the second group and the first group and the third group before surgery (P <0.05). Compared with the third group, (P <0.05). In the fourth group, the scores of anus function, incidence of spontaneous potential, MUAP duration, MUAP amplitude, percentage of polyphase wave, simple phase appearance and pathological interference were significantly different from those in the other three groups (P <0.01). In the fourth group, the scores of anus function, MUAP duration, MUAP amplitude and percentage of polyphasic wave at 3 months after operation were significantly different from preoperative and postoperative 12 months Statistical significance (P <0.05). EAS-EMG test indicators and Xu Zhong Fa score anal function score was significantly correlated (r = 0.31 ~ 0.78). Conclusions EAS-EMG is an objective measure of anal function after anal sphincter preservation in rectal cancer. EAS-EMG is consistent with the anal function score. By EAS-EMG test, it is found that lower rectal cancer is more likely to affect anal nerve and muscle Function, and anal function within 3 months after surgery significantly, 12 months to recover; for preoperative EAS-EMG with neurogenic damage in patients with rectal cancer, should be highly vigilant clinical invasion and metastasis of nerve to enhance the relevant checks And follow-up.