Evaluation of high-resolution anorectal manometry on closure of temporary ileostomy for rectal cancer patients

doi:10.3877/cma.j.issn.2095-3224.2022.03.007

Abstract

Abstract:

Objective

To evaluate whether the high-resolution anorectal manometry is associated with anal function after rectal surgery and can become a predictive method before the closure of temporary ileostomy.

Methods

170 patients with rectal cancer underwent surgery at Department of General Surgery in China-Japan Friendship Hospital between April 2017 and April 2020. Patients were classified as no low anterior resection syndrome(LARS), mild LARS, and severe LARS. According to the postoperative anal function, it was divided into two groups: no LARS group (n=75) and LARS group (n=95). According to the quality of life after closure of ileostomy, it is also divided into two groups: appropriate closure group (n=141) and inappropriate closure group (n=29). Anorectal manometry was carried out at 6 months after surgery and followed with the closure of temporary ileostomy. The results were analyzed by logistic regression between different groups.

Results

The maximal compressive pressure (P=0.032, OR=1.033) and maximal tolerant dose of defecation (P=0.011, OR=1.036) were both significantly lower in LARS group. Meanwhile, in inappropriate closure group, anal resting pressure (P=0.002, OR=1.135) and maximal compressive pressure (P=0.001, OR=1.058) were significantly lower than the other patients. The decrease of defecate sensory threshold (P=0.049, OR=1.087) and maximal tolerance dose (P=0.001, OR=1.059) were also significant.

Conclusion

Anorectal manometry can predict decreased anal function. It should be a useful evaluation method before the closure of temporary ileostomy.

Key words: Rectal neoplasms, Ileostomy, Anorectal manometry, Anal function

Dakui Zhang, Shaoxuan Chen, Zhiyong Hou, Bailong Sun, Li Yao, Wenxiao Wu, Ruixin Qu, Jianzheng Jie. Evaluation of high-resolution anorectal manometry on closure of temporary ileostomy for rectal cancer patients[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(03): 226-231.

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References 17

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特征	无前切除综合征（n=75）	轻度前切除综合征（n=66）	重度前切除综合征（n=29）	χ²值	P值
性别				0.558	0.757
男	44	38	19
女	31	28	10
年龄				0.024	0.988
≥60	38	33	15
＜60	37	33	14
ECOG评分				0.439	0.803
0	68	59	25
1	7	7	4
吻合口距肛缘距离（cm）				6.155	0.046
＜5	49	31	13
≥5	26	35	16
ISR手术				0.153	0.927
是	6	6	3
否	69	60	26
治疗前T分期				2.519	0.284
T1~2	9	6	6
T3~4	66	60	23
治疗前N分期				0.205	0.902
N0	42	35	15
N1~2	33	31	14
CEA（ng/mL）				0.058	0.971
＜5	32	29	12
≥5	43	37	17
术后化疗				3.882	0.144
有	58	47	26
无	17	19	3
还纳时间（月）				2.353	0.308
＜6	33	22	9
≥6	42	44	20
吻合口漏				0.511	0.774
有	4	2	1
无	71	64	28
直肠测压（mmHg）
静息压	90.900	60.000	38.000	115.714	＜0.001
最大缩榨压	197.500	138.400	93.100	111.047	＜0.001
残余压	61.800	60.800	60.800	1.262	0.532
肛门松弛率（%）	13.000	8.000	13.000	0.176	0.916
初始感觉阈（mL）	40.00	30.00	30.00	5.241	0.074
排便感觉阈（mL）	70.00	60.00	60.00	3.747	0.154
最大耐受量（mL）	110.00	90.00	50.00	67.555	＜0.001

特征	无前切除综合征（n=75）	轻度前切除综合征（n=66）	重度前切除综合征（n=29）	χ²值	P值
性别				0.558	0.757
男	44	38	19
女	31	28	10
年龄				0.024	0.988
≥60	38	33	15
＜60	37	33	14
ECOG评分				0.439	0.803
0	68	59	25
1	7	7	4
吻合口距肛缘距离（cm）				6.155	0.046
＜5	49	31	13
≥5	26	35	16
ISR手术				0.153	0.927
是	6	6	3
否	69	60	26
治疗前T分期				2.519	0.284
T1~2	9	6	6
T3~4	66	60	23
治疗前N分期				0.205	0.902
N0	42	35	15
N1~2	33	31	14
CEA（ng/mL）				0.058	0.971
＜5	32	29	12
≥5	43	37	17
术后化疗				3.882	0.144
有	58	47	26
无	17	19	3
还纳时间（月）				2.353	0.308
＜6	33	22	9
≥6	42	44	20
吻合口漏				0.511	0.774
有	4	2	1
无	71	64	28
直肠测压（mmHg）
静息压	90.900	60.000	38.000	115.714	＜0.001
最大缩榨压	197.500	138.400	93.100	111.047	＜0.001
残余压	61.800	60.800	60.800	1.262	0.532
肛门松弛率（%）	13.000	8.000	13.000	0.176	0.916
初始感觉阈（mL）	40.00	30.00	30.00	5.241	0.074
排便感觉阈（mL）	70.00	60.00	60.00	3.747	0.154
最大耐受量（mL）	110.00	90.00	50.00	67.555	＜0.001

肛门直肠测压指标	Wald值	P值	OR（95%CI）
静息压（mmHg）	3.781	0.052	1.073（0.999~1.152）
最大缩榨压（mmHg）	4.604	0.032	1.033（1.003~1.064）
残余压（mmHg）	0.672	0.412	1.011（0.984~1.039）
肛门松弛率（%）	1.628	0.202	1.017（0.991~1.043）
肛门抑制反射	0.105	0.746	1.344（0.225~8.044）
初始感觉阈（mL）	0.222	0.637	1.021（0.937~1.112）
排便感觉阈（mL）	0.488	0.485	1.019（0.967~1.073）
最大耐受量（mL）	6.456	0.011	1.036（1.008~1.064）

肛门直肠测压指标	Wald值	P值	OR（95%CI）
静息压（mmHg）	3.781	0.052	1.073（0.999~1.152）
最大缩榨压（mmHg）	4.604	0.032	1.033（1.003~1.064）
残余压（mmHg）	0.672	0.412	1.011（0.984~1.039）
肛门松弛率（%）	1.628	0.202	1.017（0.991~1.043）
肛门抑制反射	0.105	0.746	1.344（0.225~8.044）
初始感觉阈（mL）	0.222	0.637	1.021（0.937~1.112）
排便感觉阈（mL）	0.488	0.485	1.019（0.967~1.073）
最大耐受量（mL）	6.456	0.011	1.036（1.008~1.064）

肛门直肠测压指标	Wald值	P值	OR（95%CI）
静息压（mmHg）	9.563	0.002	1.135（1.047~1.230）
最大缩榨压（mmHg）	10.156	0.001	1.058（1.021~1.095）
残余压（mmHg）	1.769	0.184	1.029（0.986~1.073）
肛门松弛率（%）	0.024	0.877	1.003（0.970~1.036）
肛门抑制反射	1.359	0.244	5.291（0.322~83.333）
初始感觉阈（mL）	0.469	0.493	1.042（0.927~1.171）
排便感觉阈（mL）	3.893	0.049	1.087（1.001~1.180）
最大耐受量（mL）	10.132	0.001	1.059（1.022~1.097）

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