低位吻合与超低位吻合术对直肠癌的疗效比较

Comparison of Low Anastomosis and Ultra-low Anastomosis for Rectal Cancer

目的探讨低位前切除与超低位前切除术对直肠癌患者排便功能及术后生活质量的影响。方法以48例直肠癌患者为研究对象,根据保肛术式将其分为低位前切除组(23例)以及超低位前切除组(25例),术后3个月对比分析两组患者肛门控制力、便意、排便感觉等方面差异,对保肛术后排便功能的相关因素进行Logistic回归分析。结果低位前切除组肛门控制力与超低位前切除组相比无统计学差异(P>0.05),而排便感觉、便意情况、排便功能较理想,差异有统计学意义(P<0.05)。经Logistic回归分析发现,影响保肛术后排便功能的因素包括患者性别、年龄、吻合距离、临床清扫范围、肿瘤位置。低位前切除组术后3个月、6个月QOL生活质量评分显著优于超低位前切除组,差异有统计学意义(P<0.05)。结论在控便能力方面低位与超低位前切除无差异,但术后排便效果低位前切除术较超低位前切除术理想,不影响手术根治性前提下,将吻合口提高可提高术后患者生存质量。

Objective To compare the bowel function and postoperative quality of life of low anterior resection and ul- tra]ow anterior resection for rectal cancer. Methods 48 cases of anastomosis cancer patients were divided into 23 cases of low anterior resection group and 25 cases of ultra-low anterior resection group according to the sphincter preserving surgery, ability of anal control, awareness of defecation and feeling of defecation 3 months after surgery were compared and the relevant factors were studied by Logistic regression analysis. Results Ability of anal control of the 2 groups had no significant difference （ P 〉 0.05 ） , but the feeling of defecation, awareness of defecation and defecation function of the low anterior resection group were better, the difference was statistically significant （P 〈 0.05 ）. Logistic regression analysis shows that fhetors such as sex, age, consistent dis- tance,clinical dissection,tumor location affect sphincter preserving surgery postoperative defecation function. In the preoperative and postoperative 1 month,3 months,6 months for patients quality of life score sheet （QOL） score,low anterior resection group 3 months and 6 months after surgery had significantly better quality of life scores than ultra-low anterior resection group, the differ- ence was statistically significant （ P 〈 0.05 ）. Conclusion The low and ultra-low anterior resection surgery have no difference in defecation control, but defecation effect of low anterior resection was better. Without affecting radical surgery, improve anastomotie can improve the quality of life of patients.