Evaluation Of Anal Function In Anterior Resection Syndrome Patients And TCM Syndrome Differentiation

Objective:Study the anal function characteristics of rectal cancer patients with post-anterior resection syndromes at different stages;Analyze the factors affecting anal functions at different stages after surgery;Discuss the TCM syndrome differentiation typing of patients with syndromes after anterior resection for rectal cancer.Methods:A total of 16 cases of rectal cancer who underwent anterior resection for rectal cancer in the Rectal Cancer Department of Nanjing Hospital of Chinese Medicine from August 2010 to August 2019 and suffered from post-anterior resection syndromes were collected.The patients were asked to undergo anorectal manometry and fill out the LARSS three months and six months after surgery to evaluate the anal functions of patients with post-anterior resection syndromes at different stages after surgery from the two aspects of objective and subjective factors.In addition,the TCM syndrome differentiation typing of patients was performed and the self-rating anxiety scale and self-rating depression scale were filled out to analyze the characteristics of anxiety and depression in patients with different types of syndromes.Results:In terms of LARSS score,11 patients(accounting for 68.8%)were in the range of 21-29 and 5 patients(accounting for 31.3%)were in the range of 30-42 three months after the surgery.Six months after the surgery,there were 9 patients(accounting for 56.3%)with LARSS score in the range of 0-20,5 patients(accounting for 31.3%)in the range of 21-29 and 2 patients(accounting for 12.5%)in the range of 30-42.The results showed that the anal functions of patients were better six months after the surgery than three months after the surgery.As for the anorectal manometry,the anal canal rest pressure,AMCP,rectal defecation pressure,initial rectal threshold,rectal defecation sensory threshold and maximum rectum tolerance six months after the surgery were all significantly improved compared with those three months after surgery(P<0.05).In the laparoscopic/open abdomen group,there was a significant difference in the initial rectal sensory threshold three months after surgery(P<0.05).There were differences in the initial rectal sensory threshold six months after surgery in the chemoradiotherapy group(P<0.05).Among the 16 cases of TCM syndrome differentiation typing,there were five cases of spleen-deficiency and dampness-toxicity,accounting for 31.3%,five cases of spleen and kidney deficiency,accounting for 31.3%,three cases of dampness-heat and stasis-toxin,accounting for 18.9%,two cases of deficiency of both qi and blood,accounting for 12.5%and one case of yin deficiency of liver and kidney,accounting for 6.3%.Therein,the type of spleen-deficiency and dampness-toxicity as well as spleen and kidney deficiency accounted for the largest proportion,followed by the types of dampness-heat and stasis-toxin,deficiency of both qi and blood and yin deficiency of liver and kidney.In addition,four patients(accounting for 25%)developed mild anxiety and there was no patients with moderate or severe anxiety.Among them,there were two cases of spleen-deficiency and dampness-toxicity(accounting for 50%)and there was one case of dampness-heat and stasis-toxin and one case of spleen and kidney deficiency,respectively(accounting for 25%each).None of the patients developed depressive symptoms.Conclusion:The LARS score of patients with syndromes after anterior resection for rectal cancer was significantly lower six months after surgery than three months after surgery.Various indicators of anorectal manometry in patients with syndromes after anterior resection for rectal cancer were significantly improved six months after surgery compared with three months after surgery.The operation method and postoperative chemoradiotherapy had an effect on the anal functions at different postoperative stages.In terms of the TCM syndrome differentiation typing in patients with syndromes after anterior resection for rectal cancer,the types of spleen-deficiency and dampness-toxicity and spleen and kidney deficiency prevailed,followed by dampness-heat and stasis-toxin,deficiency of both qi and blood and yin deficiency of liver and kidney.Therein,the types of spleen-deficiency and dampness-toxicity,dampness-heat and stasis-toxin and spleen and kidney deficiency may be accompanied by anxiety symptoms.