针灸联合生物反馈治疗直肠癌保肛术后排便失禁的效果

doi:10.3969/j.issn.1006-9771.2020.06.018

Abstract

Abstract:

Objective To investigate the effect of acupuncture and biofeedback on the recovery of fecal incontinence after anus preservation operation for rectal cancer. Methods From January 1st, 2016 to June 30th, a total of 226 patients with rectal cancer after anus preservation operation were selected. Finally, 120 patients with fecal incontinence were randomly divided into control group (n = 40), acupuncture group (n = 40) and observation group (n = 40). All the groups accepted levator ani movement. In addition, the acupuncture group received acupuncture, and the observation group received acupuncture and biofeedback, for three months. Cleveland Clinic Florida Faecal Incontinence Scores (CCF-FIS), anorectal pressure, pelvic floor surface electromyography and quality of life were measured before treatment, and one month, two months and three months after treatment.Results There was no significant difference in CCF-FIS, anorectal pressure, pelvic floor surface electromyography and quality of life among three groups before treatment (F < 2.943, P> 0.05). After treatment, all the above indexes improved (F > 5.235, P< 0.01), and were better in the acupuncture group and observation group than in the control group (P< 0.05), especially in the observation group (P<0.05) at each time point. The curative effect of the observation group was related to the location of the tumor (χ² > 4.405, P < 0.05) one month after treatment, and it was related to whether pelvic autonomic nerve preservation was performed during the operation ( χ² > 4.706, P < 0.05) and whether radiotherapy was added after the operation ( χ² > 5.013, P < 0.05) at each time point after treatment. At three months follow-up, the recurrence rate was lower in the observation group (8.6%) than in the acupuncture group (35.7%) and in the control group (35.0%) ( χ² > 5.976, P < 0.05). No complication occurred in all groups. Conclusion Acupuncture and biofeedback can improve the symptoms of defecation incontinence and promote the recovery of anal function after anus preservation operation for rectal cancer.

Key words: rectal cancer, acupuncture, biofeedback, fecal incontinence

CLC Number:

R735.3

ZHAO Jia-ying,YIN Chen-qing,CHEN Wen-jie,CAI Yuan-kun,ZHOU Yan,LIN Yin-lu,WANG Yu-min,WANG Hui-peng,KE Zhong-wei. Effect of Acupuncture and Biofeedback on Fecal Incontinence after Anus Preservation Operation for Rectal Cancer[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(6): 715-724.

Figures/Tables 18

References 35

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项目	对照组(n = 40)	针灸组(n = 40)	观察组(n = 40)	F/χ²值	P值
年龄(岁)	68.18±9.53	67.82±9.04	66.27±8.34	0.510	0.604
性别(n)				0.871	0.647
男	17	21	18
女	23	19	22
肿瘤下极距肛缘距离(n)				0.547	0.761
> 2~10 cm	28	26	29
>10~15 cm	12	14	11
肿瘤直径(n)				0.494	0.781
≤ 3 cm	14	17	15
> 3 cm	26	23	25
病理分期(n)				1.281	0.973
Ⅰ期	4	5	6
Ⅱ期	10	11	12
Ⅲ期	16	13	12
Ⅳ期	10	11	10
手术方式(n)				0.467	0.792
腹腔镜手术	19	20	22
开放手术	21	20	18
是否PANP(n)				0.205	0.903
是	18	17	16
否	22	23	24
术后放化疗(n)				0.846	0.932
无	7	9	8
术后单纯化疗	15	14	12
术后联合放化疗	18	17	20
CCF-FIS评分	15.40±1.10	15.10±1.20	15.30±0.94	0.79	0.455

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	15.4±1.10	12.5±0.85	10.4±1.5^a	8.2±1.32^a	254.27	< 0.001
针灸组	40	15.10±1.20	10.2±0.98^a,b	7.70±1.34^a,b	4.2±0.92^a,b	666.56	< 0.001
观察组	40	15.30±0.95	7.2±0.92^a,b,c	4.3±0.95^a,b,c	2.5±0.85^a,b,c	1518.28	< 0.001
F值		0.788	335.11	226.59	310.33
P值		0.457	< 0.001	< 0.001	< 0.001

影响因素	治疗1个月		治疗2个月		治疗3个月		χ²值^a	P值^a	χ²值^b	P值^b	χ²值^c	P值^c
影响因素	有效	无效	有效	无效	有效	无效	χ²值^a	P值^a	χ²值^b	P值^b	χ²值^c	P值^c
年龄							3.095	0.079	2.533	0.112	1.600	0.206
≤ 60岁	10	4	12	2	13	1
> 60岁	11	15	16	10	20	6
性别							0.973	0.324	0.943	0.332	0.016	0.900
男性	11	7	14	4	15	3
女性	10	12	14	8	18	4
肿瘤位置							5.230	0.022	3.159	0.076	3.218	0.073
> 2~10 cm	12	17	18	11	22	7
10~15 cm	9	2	10	1	11	0
手术方法							0.852	0.356	0.173	0.677	2.395	0.122
腹腔镜	13	9	16	6	20	2
开放手术	8	10	12	6	13	5
是否PANP							13.099	< 0.001	11.429	0.001	5.657	0.017
是	14	2	16	0	16	0
否	7	17	12	12	17	7
是否联合放疗							8.120	0.004	7.619	0.006	4.329	0.037
是	6	14	10	10	14	6
否	15	5	18	2	19	1
是否联合化疗							1.380	0.240	1.451	0.228	0.998	0.318
是	13	15	18	10	22	6
否	8	4	10	2	11	1

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	27.13±5.37	31.72±5.83	34.87±6.23^a	37.85±7.42^a	21.466	< 0.001
针灸组	40	26.48±5.62	34.26±6.41^a,b	38.03±7.09^a,b	40.26±7.79^a,b	31.877	< 0.001
观察组	40	25.73±4.28	37.36±6.36^a,b,c	42.72±6.75^a,b,c	47.54±7.48^a,b,c	87.778	< 0.001
F值		0.748	8.287	13.904	17.788
P值		0.476	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	82.35±5.37	90.76±6.42	97.63±7.39^a	104.47±8.28^a	74.211	< 0.001
针灸组	40	80.68±5.84	98.62±7.33^a,b	107.42±8.46^a,b	114.35±9.71^a,b	133.677	< 0.001
观察组	40	83.72±5.62	108.34±8.27^a,b,c	123.57±10.47^a,b,c	132.64±11.14^a,b,c	219.442	< 0.001
F值		2.943	56.976	87.322	85.431
P值		0.057	< 0.001	< 0.001	< 0.001

Effect of Acupuncture and Biofeedback on Fecal Incontinence after Anus Preservation Operation for Rectal Cancer

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组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	17.25±2.56	15.62±2.17	14.28±1.83^a	13.22±1.71^a	27.676	< 0.001
针灸组	40	16.78±2.17	13.39±1.82^a,b	12.18±1.64^a,b	10.68±1.45^a,b	84.204	< 0.001
观察组	40	17.64±2.32	11.68±2.24^a,b,c	10.25±1.95^a,b,c	8.74±1.46^a,b,c	148.819	< 0.001
F值		1.337	35.924	49.539	84.618
P值		0.267	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	83.72±8.72	93.28±8.66	102.53±11.57^a	110.46±12.36^a	48.860	< 0.001
针灸组	40	81.68±8.37	100.57±10.25^a,b	118.26±12.51^a,b	125.77±13.28^a,b	121.875	< 0.001
观察组	40	84.35±8.45	115.23±10.76^a,b,c	126.68±12.35^a,b,c	134.71±14.28^a,b,c	143.644	< 0.001
F值		1.075	50.695	40.712	33.858
P值		0.345	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	6.95±2.54	6.25±2.23	5.61±1.97a	5.18±1.71a	5.235	0.002
针灸组	40	7.03±2.63	4.72±1.94^a,b	3.48±1.42^a,b	2.95±1.14^a,b	37.663	< 0.001
观察组	40	7.09±2.48	3.59±1.52^a,b,c	2.36±1.14^a,b,c	2.07±0.93^a,b,c	79.974	< 0.001
F值		0.030	19.360	45.447	60.604
P值		0.970	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	52.36±12.04	60.75±12.23	68.06±13.42^a	75.62±14.68^a	22.983	< 0.001
针灸组	40	49.36±11.23	68.62±12.32^a,b	82.23±13.46^a,b	95.75±15.86^a,b	88.328	< 0.001
观察组	40	54.28±12.15	86.48±15.74^a,b,c	94.82±17.68^a,b,c	108.22±18.92^a,b,c	78.950	< 0.001
F值		1.762	37.987	31.918	39.357
P值		0.176	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	0.37±0.12	0.33±0.09	0.30±0.07^a	0.27±0.06^a	9.419	< 0.001
针灸组	40	0.39±0.13	0.32±0.10^a,b	0.28±0.08^a,b	0.22±0.05^a,b	22.756	< 0.001
观察组	40	0.38±0.13	0.24±0.07^a,b,c	0.15±0.04^a,b,c	0.10±0.03^a,b,c	99.369	< 0.001
F值		0.249	12.696	61.705	130.857
P值		0.780	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	0.37±0.14	0.33±0.12	0.28±0.10^a	0.27±0.09^a	6.628	< 0.001
针灸组	40	0.38±0.13	0.29±0.11^a,b	0.24±0.09^a,b	0.20±0.07^a,b	22.952	< 0.001
观察组	40	0.36±0.12	0.22±0.08^a,b,c	0.16±0.05^a,b,c	0.11±0.04^a,b,c	75.127	< 0.001
F值		0.236	11.307	21.748	52.877
P值		0.790	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	5.74±2.43	4.89±1.98	4.22±1.76^a	3.84±1.62^a	7.151	< 0.001
针灸组	40	5.83±2.25	3.72±1.52^a,b	2.97±1.29^a,b	2.27±1.05^a,b	37.425	< 0.001
观察组	40	5.76±2.42	3.21±1.64^a,b,c	2.45±1.13^a,b,c	2.04±0.92^a,b,c	41.754	< 0.001
F值		0.016	9.980	16.447	25.180
P值		0.984	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	1.26±0.20	0.98±0.10	0.76±0.08^a	0.64±0.04^a	204.874	< 0.001
针灸组	40	1.31±0.23	0.78±0.08^a,b	0.45±0.06^a,b	0.26±0.04^a,b	524.734	< 0.001
观察组	40	1.28±0.21	0.52±0.06^a,b,c	0.31±0.04^a,b,c	0.12±0.03^a,b,c	824.515	< 0.001
F值		0.555	319.200	548.621	2119.024
P值		0.576	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	2.57±0.64	2.12±0.58	1.73±0.46^a	1.25±0.32^a	47.672	< 0.001
针灸组	40	2.68±0.70	1.53±0.46^a,b	1.16±0.35^a,b	0.75±0.26^a,b	123.677	< 0.001
观察组	40	2.60±0.63	1.38±0.36^a,b,c	0.87±0.22^a,b,c	0.42±0.13^a,b,c	239.223	< 0.001
F值		0.299	27.102	60.058	112.124
P值		0.742	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	2.84±0.74	2.38±0.60	1.92±0.48^a	1.37±0.40^a	48.825	< 0.001
针灸组	40	2.75±0.78	1.86±0.64^a,b	1.27±0.45^a,b	0.95±0.33^a,b	75.233	< 0.001
观察组	40	2.83±0.72	1.48±0.54^a,b,c	0.93±0.36^a,b,c	0.56±0.22^a,b,c	160.205	< 0.001
F值		0.174	23.083	53.980	62.061
P值		0.840	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	3.05±0.76	2.37±0.63	1.76±0.48^a	1.38±0.30^a	66.023	< 0.001
针灸组	40	3.08±0.75	2.05±0.58^a,b	1.46±0.43^a,b	0.97±0.26^a,b	114.550	< 0.001
观察组	40	3.04±0.72	1.65±0.53^a,b,c	0.96±0.35^a,b,c	0.58±0.21^a,b,c	194.299	< 0.001
F值		0.031	15.397	36.445	95.211
P值		0.969	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	1.29±0.35	1.55±0.37	1.73±0.42^a	2.36±0.51^a	47.737	< 0.001
针灸组	40	1.28±0.37	1.92±0.38^a,b	2.57±0.45^a,b	3.05±0.58^a,b	116.011	< 0.001
观察组	40	1.26±0.33	2.63±0.46^a,b,c	3.24±0.55^a,b,c	3.62±0.67^a,b,c	160.009	< 0.001
F值		0.076	73.337	100.810	45.697
P值		0.927	< 0.001	< 0.001	< 0.001

组别	n	治疗前	治疗1个月	治疗2个月	治疗3个月	F值	P值
对照组	40	1.63±0.34	1.88±0.38	2.04±0.45^a	2.25±0.53^a	14.736	< 0.001
针灸组	40	1.55±0.32	2.08±0.53^a,b	2.45±0.67^a,b	2.86±0.73^a,b	36.338	< 0.001
观察组	40	1.58±0.36	2.75±0.54^a,b,c	3.22±0.78^a,b,c	3.56±0.85^a,b,c	68.272	< 0.001
F值		0.564	34.755	34.186	33.564
P值		0.571	< 0.001	< 0.001	< 0.001

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