直肠癌患者三种肠道重建术对肛门功能的影响比较

Effect of different intestinal reconstruction of anal function in rectal cancer

目的探讨不同肠道重建术对低位直肠癌患者肛门功能的影响。方法将120例低位直肠癌患者随机分为吻合组(行直接吻合术)、结袋组(行结肠成形袋术)、J型袋组(行J型贮袋术)各40例,随访12个月后比较三组患者的肛门功能。结果吻合组、结袋组、J袋组成功率分别为95.0%、97.0%、95.0%,组间比较差异无统计学意义(P>0.05);术后6、12个月结袋组和J型袋组患者肛门功能主观感受评分均高于吻合组患者;术后3、6、12个月吻合组患者24h排便次数、不能区分排便与排气率均高于结袋组和J型袋组患者;术后12个月吻合组患者最大收缩压、直肠顺应性均显著低于结袋组和J型袋组患者;术后3、6、12个月吻合组患者最大耐受量、静息压均显著低于结袋组和J型袋组患者,以上差异均有统计学意义(P<0.05)。结论低位直肠癌患者行全直肠结肠系膜切除术后,直接吻合术对患者肛门功能的影响最大,J型贮袋术、结肠成形袋术对患者肛门功能影响接近,可以根据患者的生理类型行肠道重建术治疗,以最大程度保留患者肛门功能。

Objective To investigate affect of different intestinal reconstruction of anal function in low rec- tal cancer. Methods One hundred and twenty cases of low rectal cancer were randomly divided into anastomosis group （patients were treated with direct anastomosis）, colon forming group （patients were treated with colon shaping marsupialization）, J pouch group （patients were treated with J pouch surgery）, with 40 cases in each group. The anal function in 3 groups were observed after 12 months. Results The success rates of anastomosis group, colon forming group and J pouch group were 95%, 97%, 95%, with no statistically significant difference among the three groups （ P〉0.05）. After six and twelve months,the sub- jective scores of anal function in patients with the colon forming group and J pouch group of were higher than the anastomosis group, which were statistically significant （ P 〈0.05）. After three, six and twelve months,the 24h defecation, incapacity of bowel movements and exhaust in the anastomosis group were higher than the colon forming group and J pouch group, which were statistically significant difference （ P 〈0.05）. After 12 months, the systolic blood pressure and rectal compliance in patients of anastomosis group were significantly lower than those in the colon forming group and J pouch group, which were statistically significant difference （ P 〈0.05）. After three, six and twelve months,the maximum tolerance and resting pressure in the anastomosis group were significantly lower than those in the colon forming group and J pouch group, which were statistically significant difference （ P d0.05 ）. Conclusion Direct anastomosis has the most remarkable influence of anal function in low rectal cancer after total mesorectal excision. To the greatest extent with preservation of anal function, the colon forming bags and J pouch surgery could improve postoperative anal function, according to the physiological types for enteric reconstruction,.