高龄低位直肠癌不同吻合平面保肛术后对控便功能的影响

The effect of anus-retained operation in different anastomotic location on bowel control in elderly patients with low rectal cancer

目的评价高龄低位直肠癌不同吻合平面保肛手术后肛门控便功能。方法对2000～2003年39例采用保肛手术治疗的低位直肠癌病人分别按吻合口位置分组,对术后控便情况进行研究。结果病人排便次数达到正常的时间为术后(9.8±2.86)个月,术后36.1%病人出现I度失禁的表现。低位吻合组与超低位吻合组比较术后控便情况差异无统计学意义,贮袋组与直肠吻合组比较术后控便情况差异有统计学意义。结论高龄低位直肠癌低位吻合与超低位吻合术后对控便机能影响差异不明显,采用结肠贮袋直肠肛管吻合术能够明显改善高龄病人近期的控便功能。

Objective To evaluate the bowel control of the anus-retained operation in different anastomotic l^ation in eld- erly patients with low rectal cancer. Methods Thirth-nine cases of the elderly patients（ t〉75 years）with low rectal eaneer who receipted surgery between 2000 and 2003 were divided into various groups according to different anastomotic location. The bowel control and satisfaction of patients were investigated. Results The time of recovering normal bowel frequency was （9. 8±2.9） months. 36. 1% of the patients experienced some problems with continence. There were no difference on bowel function between lower anastomosis group and lowest anastomosis group. The patients with colonic J-pouch-anal anastomosis displayed significantly better function in terms of defecation per 24h postoperatively,and bowel movement and anorectal manometric findings（ P 〈0. 05）. Conclusion For the elderly patients with rectal cancer of the anus-retalned operation, there are no differences on bowel function between lower anastomosis group and lowest anastomosis group. However, Co- Ionic J-pouch-anal anastomosis after the anus-retained operation can significantly improve the bowel function.