结直肠侧端吻合改善低位直肠癌前切除术后排便功能

Colorectal Side-to-end Anastomosis Improving Postoperative Bowel Function in Patients with Low Rectal Cancer After Anterior Resection

[目的]评价侧端吻合术改善低位直肠癌前切除术后排便功能。[方法]对低位直肠癌前切除保肛术病例60例,行结肠—直肠(或肛管)侧端吻合术与结肠—直肠(或肛管)端端吻合术重建消化道各30例,于术后6个月及12个月评价排便功能。[结果]侧端吻合组发生术后并发症7例,端端吻合组发生术后并发症共8例,两组术后并发症发生率无统计学差异(χ2=0.089,P=0.766)。术后6个月时,侧端吻合组大便Ⅰ度失禁发生率为10.0%,明显少于端端组的30.0%(χ2=4.320,P=0.038)。侧端吻合组里急后重发生率为26.7%,明显少于端端组的60.0%(χ2=6.687,P=0.009)。侧端吻合组控便满意率为83.3%,明显好于端端组的60.0%(χ2=4.022,P=0.045)。两组患者在术后12个月控便能力均恢复正常。[结论]侧端吻合术并不增加术后并发症,而且改善近期术后排便功能效果。

Purpose To evaluate the bowel function in low rectal cancer patients with side-to-end anastomosis after anterior resection. Methods Sixty cases with low rectal cancer with anus preserving operation of anterior resection were divided into two groups： 30 cases underwent colorectal or coloanal side-to-end anastomosis,and 30 cases underwent colorectal or coloanal end-to-end anastomosis. Bowel function were assessed at 6 and 12months postoperation. Results Postoperative complications developed in 7 cases in side-to-end anastomosis group and 8 cases in end-to-end anastomosis group without significant difference between them （χ2 = 0.089,P = 0.766）. At 6 months postoperation,fecal incontinence grade I was 10.0% in side-to-end anasto- mosis group,which was significantly less than that in end-to-end group （30.0%） （χ2 = 4.320,P= 0.038）. Tenesmus in side-to-end anastomosis group （26.7% ）was significantly less than that in end-to-end group （60.0%）（ χ2 =6.687,P=0.009）. Satisfaction rate of fecal control in side-to-end anastomosis group was 83.3% ,which was significantly better than that in end-to-end group （60.0%）（χ2 =4.022,P=0.045）. All the patients in the two groups recovered to normal fecal control 12 months postoperation. Conclusion Side-to-end anastomosis can improve the postoperative bowel function without increasing postoperative complications for patients with low rectal cancer.