J形贮袋和T形贮袋在低位直肠癌前切除术中的应用及对比研究

Research and application of the colon J-pouch and the transverse coloplasty pouchin low rectal cancers after anterior resection

目的：对比评价J形贮袋（CJP）和T形贮袋（TCP）在低位直肠癌前切除术后对改善患者排控便功能的作用。方法：对比分析2004年3月～2005年5月行J形结肠贮袋成形术的11例、T形结肠贮袋成形术10例和直接吻合（对照组）10例患者的临床资料。结果：术后3个月时J形贮袋组结肠贮袋最大耐受容量为（198．6±18．9）mL、便意诱发容量为（142．9±13．0）mL、顺应性为（5．5±0．9）mL／mmHg；T彤贮袋组分别为（160．5．6±14．6）mL、（108．2±7．8）mL和（5．2±0．6）mL／mmHg；对照组分别为（116．8±15．4）mL、（81．7±8．8）mL和（3．3±0．5）mL／mmHg。贮袋组贮袋最大耐受容量、便意诱发容量及肠顺应性均优于对照组，P〈0．05，且CJP组的贮袋最大耐受容量、便意诱发容量均优于TCP组，P〈0．05，3组间术后并发症无明显差别。结论：低位直肠癌前切除术应用J形贮袋和T形贮袋扩大了“新直肠”容积，提高了肠顺应性，明显改善排控便功能，提高了患者的生活质量。

OBJECTIVE： To compare the two pouch reconstruction techniques of the colon J-pouch （CJP） and the transverse coloplasty pouch （TCP） in terms of bowel function in low rectal cancers after anterior resection. METHODS： Clinical-pathological data from 11 cases of CJP and 10 cases of TCP and 10 cases of the straight coloanal anastomosis （control） were analyzed retrospectively form March 2004 to May 2005. RESULTS： After 3 months of operation, maximum tolerable volume （198. 6±18.9）mL, inducing cacation volume （ 142. 9 ± 13. 0） mL, rectal compliance （5.5±0.9 mL/mmHg） were reduced in CJP, respectively, and the data of TCP and control were 160.5±14.6 mL, 108.2±7.8 mL, 5.2±0.6 mL/mmHg and 116.8±15.4 mL, 81.7±8.8 mL, 3.3±0.5 mL/mmHg. Maximum tolerable volume, inducing cacation volume and rectal compliance were significantly better after the colonic pouch reconstruction than after the straight anastomosis （P〈0.05）. Maximum tolerable volume and inducing eaeation volume were significantly better after CJP than after TCP （P〈0. 05）. There was no significant difference in the complications of the three techniques. CONCLUSION： It is suggested that CJP and TCP enlarge the volume of ＂neorectum＂, raise the rectal compliance, improve bowel function and make better quality of life.