结肠成形袋对改善直肠癌术后排便功能的作用

Effect of transverse coloplasty pouch and coloanal anastomosis on improving defecation after resection for rectal carcinoma

目的评价中下段直肠癌行结肠成形袋结肠-直肠(肛管)吻合术对改善术后排便功能的作用。方法将61例中下段直肠癌患者随机分成2组,第1组31例,制成结肠成形袋后与直肠(肛管)端端吻合(TCP组);第2组30例,行结肠断端与直肠(肛管)端端吻合(CAA组)。分别于术后3、6、12、15个月对患者排便功能进行评价。结果术后15个月时,TCP组患者每日平均排便2次、便后1h内需再排便者占4%、排便失禁综合评价0,均优于CAA组(分别为4次、12%和4);两组比较,差异有显著性意义(P<0.05)。术后6个月时TCP组直肠最大耐受压和顺应性压明显增加,分别为(162.3±2.0)ml/kPa和(28.3±1.7)ml/kPa,与CAA组(154.3±1.9)ml/kPa和(26.5±1.1)ml/kPa相比,差异有显著性意义(P<0.05)。术后两组出现吻合口瘘各1例。TCP组发生吻合口狭窄1例。结论结肠成形袋结肠-直肠(肛管)吻合术能明显改善直肠癌术后患者的排便功能。

Objective To evaluate the effect of transverse coloplasty pouch and coloanal anastomosis after low anterior resection for middle or low rectal cancer on improving the bowel function. Methods A prospective randomized trail was carried out. Sixty one consecutive patients undergoing low anterior resection were divided into two groups,straight coloanal anastomosis group (CAA,n=30) and transverse coloplasty pouch group(TCP,n=31),based on the reconstruction of intestinal continuity. All patients were followed up and evaluated at 3,6,12 and 15 months postoperatively. Results Patients in TCP group had better bowel function than those in CAA group. The defecation frequency was one time per 24 h and the proportion of the patients who needed to defecate again within 1 h was 4%in TCP group, while 4 times per 24 h and 12%in CAA group (P< 0.05). The maximal tolerated volume and compliance were (162.3±2.0)ml/kPa and (28.3±1.7)ml/kPa in TCP group,significantly higher than (154.3±1.9)ml/kPa and (26.5±1.1)ml/kPa in CAA group at 6 months after operation(P< 0.05). Each group had one anastomotic leakage. One anastomotic stricture occurred in TCP group. Conclusion Transverse coloplasty pouch and coloanal anastomosis after low anterior resection can significantly improve the bowel function of rectal cancer.