75岁以上高龄患者低位直肠癌保肛手术后控便情况分析

Bowel control of anus-preserving operation for low rectal cancer in elderly patients over 75 years

目的评价高龄患者低位直肠癌保肛手术后的肛门控便功能。方法对年龄在75岁以上、肿瘤距肛缘7cm以下、采用保肛手术治疗的39例低位直肠癌患者,按吻合口位置和手术方式分组,研究术后控便情况。结果患者排便次数达到正常的时间为术后(9.8±2.9)个月。肛门控便情况和直肠测压结果在低位吻合组与超低位吻合组及肛管吻合组之间比较,差异均无统计学意义(P>0.05);肛管吻合组与超低位吻合组之间比较,差异有统计学意义(P<0.05)。贮袋组术后(7.7±1.7)个月排便次数趋于正常,与直吻组(10.6±2.8)个月比较,差异有统计学意义(P<0.01);术后36.1%的患者出现I度失禁的表现,贮袋组与直吻组比较,差异无统计学意义(P>0.05);保肛术后贮袋组直肠测压指标优于直吻组。结论高龄患者采用结肠贮袋直肠肛管吻合术能够明显改善近期的控便功能。

Objective To evaluate the bowel control of the anus-preserving operation for elderly patients over 75 years with low rectal cancer. Methods Thirty-nine elderly patients over 75 years with low rectal carcinoma （4 -7 cm from anal verge） were treated during the study period. The patients were divided into different groups according to the surgical procedures and anastomotic locations. The bowel control and patients＇ satisfaction were compared. Results The time of recovering normal defecation frequency was （9.8 ~ 2.9） months. There were no differences in bowel control and anorectal manometric findings between the lower anastomosis group and super-lower anastomosis group, the lower anastomosis group and anorectal anastomosis group. The patients in anorectal anastomosis group displayed significantly better bowel control and anorectal manometric findings than those in the super-lower anastomosis group（ P 〈 O. 05）. The time of recovering normal defecation frequency in colonic J-pouch-anal anastomosis group was（7.7 ~ 1.7） months, shorter than（ 10.6 ~ 2.8） months in direct anastomosis group（ P 〈 0.01 ）. The complication rate of I degree incontinence was 36.1%, but there was no difference between the two groups. The anorectal manometric findings were better in J-pouch-anal anastomosis group than those in direct anastomosis group （ P 〈 0. 05 ） . Conclusion Colonic J-pouch-anal anastomosis for lower rectal carcinoma can significantly improve the bowel control in a short term without increasing the complication rate.