结肠成形术预防低位直肠癌术后前切除综合征的疗效分析

Effects of transverse coloplasty pouch for preventing the occurrence of anterior resection syndrome after low anastomosis for rectal cancer

目的评价低位直肠癌前切除术中采用结肠成形术(transverse coloplasty pouch anastomosis)对预防前切除术后综合征的疗效。方法将2007年8月至2008年7月行低位直肠癌前切除术的直肠癌患者40例随机分为两组,一组采用结肠成形术20例,制作结肠贮袋长约5 cm,另一组采用传统的结肠、直肠端端吻合术术(end to end anastomosis)20例,通过术后3,6,9,12个月随访比较两组手术并发症及排便功能。结果术后并发症中,两组均无死亡病例、无临时性造口病例,无吻合口漏发生,无吻合口狭窄发生。直吻组出现1例吻合口出血,2例局部复发,成形组1例局部复发。术后6个月时排便功能成形术组优于传统组,差异有统计学意义(P<0.05);术后9个月时两组各项指标比较,仅大便失禁评分成形组优于传统组,差异有显著性(P<0.05),其他各项指标比较均无明显差异(P>0.05);术后12个月以上两组上述指标基本类似,两组比较,差异无统计学意义(P>0.05),结论对于低位直肠癌在行根治性手术的前提下采用结肠成形术可以明显改善术后一年左右的直肠功能,预防术后前切除术后综合征并且不增加术后并发症。

Aim To evaluate the effects of transverse coloplasty pouch for preventing the occurrence of anterior resection syndrome after low anastomosis for rectal cancer. Methods A prospective randomized trail was made. Between August 2007 and July 2008,40 patients undergoing low anterior resection were divided into two groups based on the reconstruction of intestinal continuity：traiditonal straight coloanal anastomosis （ straight group, N = 20） or 5cm transverse coloplasty pouch（ treatment group）. Patients were followed-up and evaluated at 3,6,9,12 months postoperatively. Both groups were compared in surgical complications and bowel function. Results These two groups were well matched for gender, age, histologic stage, no anastomotie structure were found in these two groups. There was one postoperative bleeding in straight group,no anastomotie leakage and postoperative death was found. Recurrence occurred in 2 cases in straight group, 1 case in treatment group respectively. Patients with transverse coloplasty pouch anastomosis displayed significantly better function in terms of frequency of defecation per 24 hours postoperatively （ 6 months ： 5 vs. 2, P 〈 0.05,12 months ： 3 vs. 1, P 〈 0.05 ）. Conclusion Transverse coloplasty pouch anastomosis after low anterior resection can significantly improve the bowel function and decrease the rate of occurrence of anterior resection syndrome without increasing complication rate.