超高龄低位直肠癌保肛手术对控便功能的影响

Bowel control of the anus-retained operation for elderly low rectal cancer patients

目的探讨超高龄(≥75岁)低位直肠癌保肛手术对肛门控便功能的影响。方法选取39例年龄≥75岁,肿瘤距离肛缘≤7cm的低位直肠癌患者,分别采用不同的保肛手术治疗,对患者术后控便情况进行了对比研究。结果36例患者入组研究,患者排便次数达到正常的时间为(9.8±2.86)个月;贮袋组术后(7.67±1.66)个月排便次数趋于正常,与直吻组(10.56±2.83)个月比较差异有统计学意义,P=0.001;术后36.1%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=0.067;保肛术后贮袋组直肠测压指标优于直吻组。术后1年91.7%的患者对控便情况表示满意。结论超高龄老年患者虽然保肛术后对于控便能力有所下降,但是这种控便能力的下降是可接受的,且采用结肠贮袋直肠肛管吻合术能够明显改善超高龄患者近期的控便功能。

OBJECTIVE： To evaluate the bowel control of the anus-retained operation for elderly （≥75） low rectal cancer patients. METHODS： Thirty-nine cases of the elderly （≥75） low rectal carcinoma （from anal verge 5-8 cm） were treated during the study period. They were divided into direct anastomosis group and colonic J-pouch anastomosis group. The bowel control and satisfaction of patients were investigated. RESULTS： Thirty-six patients were in the study group. The time of recovering normal frequence was （9.8 ± 2.86） months, the colonic J-pouch anastomosis group had shorter defecation recovery time than the direct anastomosis group, P= 0. 001, and 36. 1% patients were experiencing some problems with continence. Patients with colonic J-pouch-anal anastomosis displayed significantly better function in terms of defecation per 24 hours postoperatively, but there was no significant difference, P=0. 067, Colonic J-pouch anastomosis group resulted in superior anorectal manometric findings to direct anastomosis group. At one year, the rate of satisfaction owas 91.7%. CONCLUSIONS： The elderly patients than aged more than 75 years with rectal cancer of the anus-retained operation has a reasonable expectation of acceptable continence. Colonic J-pouch-anal anastomosis after the anus-retained operation can significantly improve the bowel function without increasing complication rate.