高龄低位直肠癌患者保肛手术后控便功能分析

Bowel Control of Elderly Low Rectal Cancer Patients after Anus-retained Operation

背景与目的:虽然保肛手术已在当前的直肠癌根治手术中占主导地位,但多数外科医生由于担心患者术后控便功能下降,都不愿向高龄低位直肠癌患者推荐低位吻合术。本研究对高龄低位直肠癌患者保肛术后肛门控便情况进行探讨和分析。方法:选取高龄低位直肠癌病例80例,分成两个年龄组,≥75岁年龄组39例,60￣74岁年龄组41例,收集患者的临床资料,包括治疗手段、并发症等。术后18个月内对患者肠道功能、控便情况及满意度等资料进行随访记录,并对两组患者术后控便情况进行比较。结果:术后18个月,79例(98.8%)患者生存,76例可评价肛门控便情况,其中≥75岁年龄组36例,60￣74岁年龄组40例。术后3个月肛门功能评价显示≥75岁年龄组较60￣74岁年龄组差(P<0.05),但术后半年时这种差异无统计学意义(P>0.05)。术后排便次数恢复正常的时间:≥75岁年龄组较60￣74岁年龄组虽有所延长,但无显著性差异(P>0.05)。≥75岁年龄组术后13例出现了Ⅰ度失禁的表现,与60￣74岁年龄组有显著性差异(P<0.05)。患者术后大便失禁经药物治疗后症状可缓解。结论:老年低位直肠癌患者保肛术后能保持较好的控便能力,高龄不应成为低位直肠癌保肛术的禁忌证。

BACKGROUND ＆ OBJECTIVE： Though anus-retained operation has became the first choice in radical cure operation for rectal cancer, most surgeons whom fear of dissatisfied bowel control after operation recommend permanent bowel stoma in abdomen for elderly low rectal cancer patients rather than anus-retained operation. This study was to evaluate the bowel control of elderly low rectal cancer patients after anus-retained operation. METHODS： A total of 80 elderly low rectal cancer patients were divided into ≥75-year old group （39 patients） and 60-74-year old group （41 patients）. Clinical data and follow-up data of the 80 patients were analyzed; bowel function and continence of the 2 groups were compared. RESULTS： The postoperative 18-month survival rate of all patients was 98.8%. The bowel control statuses of 76 patients were evaluable, of which 36 were in ≥75-year old group, 40 were in 60-74-year old group. Three months after operation, the bowel function was significantly poorer in ≥75-year old group than in 60- 74-year old group （P〈0.05）, but the difference dissolved 6 months after operation （P〉0.05）. The time of recovering normal defecation frequence was slightly longer in ≥75-year old group than in 60-74-year old group （P〉0.05）. The prevalence of grade I incontinence 6 months after operation was significantly higher in ≥75-year old group than in 60-74-year old group （36.1% vs. 12.5%, P〈0.05）, but all symptoms of incontinence were relived after treatment. CONCLUSIONS. Most elderly low rectal cancer patients could maintain bowel control after anus-retained operation. Age alone should not be a contraindication to a restorative resection for low rectal cancer,