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Abstract：
OBJECTIVE: This study aimed to clarify the relationship between changes in elasticity and anorectal function before and after chemoradiotherapy.
METHODS: This is a single-center prospective cohort study (Department of Surgical Oncology, The University of Tokyo). We established a technique to quantify internal anal sphincter hardness as elasticity using transanal ultrasonography with real-time tissue elastography. Twenty-seven patients with post-chemoradiotherapy rectal cancer during 2019-2022 were included. Real-time tissue elastography with transanal ultrasonography was performed before and after chemoradiotherapy to measure internal anal sphincter hardness as \"elasticity\" (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). The relationship between the increase or decrease in elasticity pre- and post-chemoradiotherapy and the maximum resting pressure, maximum squeeze pressure, and Wexner score were the outcome measures.
RESULTS: A decrease in elasticity was observed in 16/27 (59.3%) patients after chemoradiotherapy. Patients with and without elasticity decrease after chemoradiotherapy comprised the internal anal sphincter sclerosis and non-sclerosis groups, respectively. The maximum resting pressure post-chemoradiotherapy was significantly high in the internal anal sphincter sclerosis group (63.0 mmHg vs. 47.0 mmHg), and a majority had a worsening Wexner score (60.0% vs. 18.2%) compared with that of the non-sclerosis group. Decreasing elasticity (internal anal sphincter sclerosis) correlated with a higher maximum resting pressure (r = 0.36); no correlation was observed between the degree of elasticity change and maximum squeeze pressure.
CONCLUSIONS: Internal anal sphincter sclerosis due to chemoradiotherapy may correlate to anorectal dysfunction.
METHODS: This is a single-center prospective cohort study (Department of Surgical Oncology, The University of Tokyo). We established a technique to quantify internal anal sphincter hardness as elasticity using transanal ultrasonography with real-time tissue elastography. Twenty-seven patients with post-chemoradiotherapy rectal cancer during 2019-2022 were included. Real-time tissue elastography with transanal ultrasonography was performed before and after chemoradiotherapy to measure internal anal sphincter hardness as \"elasticity\" (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). The relationship between the increase or decrease in elasticity pre- and post-chemoradiotherapy and the maximum resting pressure, maximum squeeze pressure, and Wexner score were the outcome measures.
RESULTS: A decrease in elasticity was observed in 16/27 (59.3%) patients after chemoradiotherapy. Patients with and without elasticity decrease after chemoradiotherapy comprised the internal anal sphincter sclerosis and non-sclerosis groups, respectively. The maximum resting pressure post-chemoradiotherapy was significantly high in the internal anal sphincter sclerosis group (63.0 mmHg vs. 47.0 mmHg), and a majority had a worsening Wexner score (60.0% vs. 18.2%) compared with that of the non-sclerosis group. Decreasing elasticity (internal anal sphincter sclerosis) correlated with a higher maximum resting pressure (r = 0.36); no correlation was observed between the degree of elasticity change and maximum squeeze pressure.
CONCLUSIONS: Internal anal sphincter sclerosis due to chemoradiotherapy may correlate to anorectal dysfunction.
摘要：
目的：本研究旨在阐明放化疗前后弹性变化与肛门直肠功能的关系。
方法：这是一项单中心前瞻性队列研究（肿瘤外科，东京大学）。我们建立了一种使用经肛门超声和实时组织弹性成像将肛门内括约肌硬度量化为弹性的技术。纳入2019-2022年期间27例放化疗后直肠癌患者。在放化疗前后进行经肛门超声实时组织弹性成像，以测量肛门内括约肌硬度为“弹性”（最硬（0）至最软（255）；弹性降低表明硬化变化）。放化疗前后弹性的增加或减少与最大静息压之间的关系，最大挤压压力,Wexner评分是结果指标。
结果：放化疗后，16/27（59.3％）患者的弹性下降。放化疗后弹性下降的患者包括肛门内括约肌硬化和非硬化组，分别。在肛门内括约肌硬化组中，放化疗后的最大静息压力显着升高（63.0mmHg与47.0mmHg)，大多数人的韦克斯纳得分恶化(60.0%vs.18.2％）与非硬化组相比。弹性降低（肛门内括约肌硬化）与较高的最大静息压力相关（r=0.36）；在弹性变化程度和最大挤压压力之间没有观察到相关性。
结论：放化疗引起的肛门内括约肌硬化可能与肛门直肠功能障碍有关。
方法：这是一项单中心前瞻性队列研究（肿瘤外科，东京大学）。我们建立了一种使用经肛门超声和实时组织弹性成像将肛门内括约肌硬度量化为弹性的技术。纳入2019-2022年期间27例放化疗后直肠癌患者。在放化疗前后进行经肛门超声实时组织弹性成像，以测量肛门内括约肌硬度为“弹性”（最硬（0）至最软（255）；弹性降低表明硬化变化）。放化疗前后弹性的增加或减少与最大静息压之间的关系，最大挤压压力,Wexner评分是结果指标。
结果：放化疗后，16/27（59.3％）患者的弹性下降。放化疗后弹性下降的患者包括肛门内括约肌硬化和非硬化组，分别。在肛门内括约肌硬化组中，放化疗后的最大静息压力显着升高（63.0mmHg与47.0mmHg)，大多数人的韦克斯纳得分恶化(60.0%vs.18.2％）与非硬化组相比。弹性降低（肛门内括约肌硬化）与较高的最大静息压力相关（r=0.36）；在弹性变化程度和最大挤压压力之间没有观察到相关性。
结论：放化疗引起的肛门内括约肌硬化可能与肛门直肠功能障碍有关。
