[Rehabilitation program for patients with low anterior resection syndrome].
[Rehabilitation program for patients with low anterior resection syndrome].
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DOI：
10.17116/kurort20209705152
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发表时间：
2020-01-01
影响因子：
--
通讯作者：
Nafedzov, I O
中科院分区：
文献类型：
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作者：
Fomenko, O Yu;Kashnikov, V N;Nafedzov, I O
直肠癌的手术治疗和保留括约肌的低位前切除术会导致排便障碍（低位前切除综合征 - LARS）。目前尚无针对 LARS 患者治疗及其康复计划的临床建议。目的：为低位前切除综合征患者制定康复计划。材料和方法：调查分两个阶段进行。在第一阶段，对 29 名 LARS 患者（17 名（58.6%）男性，参与者平均年龄 61.5±9.5 岁）和 12 名（41.4%）女性（平均年龄 61.2±7.8 岁）进行了检查，并接受了按照标准方案进行的生物反馈疗法的保守治疗。在第二阶段，17 名患者（平均年龄 61.4±12.7 岁）——9 名（52.9%）名男性、8 名（47.1%）名女性接受了生物反馈治疗结合胫骨神经调节（TNM）。通过肛门直肠测压、括约肌测量以及治疗前后直肠储库功能的研究来评估所有患者的直肠和锁定装置的功能状态。 结果：开发的综合康复措施改善了直肠癌患者的治疗效果，改善了低位前切除术后的生活质量，减少了 LARS 的表现（减少了 47.8%）。 36.4%的患者保持稳定的积极治疗结果，54.5%的患者根据LARS量表治疗的积极动态略有下降，9.1%的患者在保守康复后3-6个月内指标恶化。在第一阶段，整个队列达到最大挤压压力改善（p=0.047），在第二阶段，仅女性在休息时（p=0.01）和挤压期间（p=0.025）的压力值出现这种趋势。获得的数据使我们能够向 63.6% 的患者推荐重复疗程。作者修改和优化了一种特殊的物理治疗综合体，用于医疗机构和家庭患者的康复。这些练习的目的是改善盆底肌肉和括约肌的功能状态。结论：低位前切除综合征患者的康复方案应包括：1）生物反馈治疗，改善握持功能；2）低位前切除综合征患者的康复治疗。 2）生物反馈疗法，旨在改善直肠的储库功能和充盈敏感性； 3）胫骨神经调节。该计划可能有助于改善肛门括约肌的收缩性和直肠的储存功能，以及排便冲动的出现。
Surgical treatment of rectal cancer and sphincter-preserving low anterior resection results to evacuation disorders (low anterior resection syndrome - LARS). There are no clinical recommendations for the treatment of patients with LARS as well as a rehabilitation program for them.OBJECTIVE: To develop a rehabilitation program for patients with low anterior resection syndrome.MATERIAL AND METHODS: The investigation was performed at 2 stages. During the first stage, 29 patients with LARS (17 (58.6%) men, mean age of the participants' 61.5±9.5 years), 12 (41.4%) women (mean age 61.2±7.8 years) were examined and received the course of conservative treatment with the use of biofeedback-therapy performed by the standard protocol. On the second stage, 17 patients (mean age 61.4±12.7 years) - 9 (52.9%) men, 8 (47.1%) women received biofeedback therapy in combination with tibial neuromodulation (TNM). Functional state of the rectum and the locking apparatus in all patients were evaluated by anorectal manometry: sphincterometry and studies of the reservoir function of the rectum before and after treatment.RESULTS: The developed complex of rehabilitation measures led to improved treatment results for patients with rectal cancer by improving the quality of life after low anterior resection, reducing the manifestations of LARS (by 47.8%). Stable positive results of treatment were maintained in 36.4% of patients, positive dynamics from the treatment according to the LARS scale decreased slightly in 54.5%, deterioration of indicators in 3-6 months after conservative rehabilitation was registered in 9.1% of cases. At the first stage maximal squeeze pressure improvement was reached in the whole cohort (p=0.047), at the second stage these trend was seen only for women for the pressure values at rest (p=0.01) and during squeeze (p=0.025). The data obtained allowed us to recommend a repeat course of treatment to 63.6% of patients. The authors modified and optimized a special complex of physical therapy for the rehabilitation of patients both in a medical institution and at home. These exercises are aimed at improving the functional state of the pelvic floor muscles and sphincter apparatus.CONCLUSION: Rehabilitation program for patients with low anterior resection syndrome should include: 1) biofeedback therapy to improve the holding function; 2) biofeedback therapy aimed at improving the reservoir function and sensitivity of the rectum to filling; 3) tibial neuromodulation. This program may help improving the contractility of the anal sphincter and reservoir function of the rectum, as well as the appearance of the urge to defecate.