结肠贮袋直肠肛管吻合术对改善直肠癌术后排便功能的作用

Effects of colonic reservoir construction and coloanal anastomosis on improving defecation after resection for rectal carcinoma Adamou HJ

目的评价中下段直肠癌低前切除结肠J型贮袋———直肠或肛管吻合对改善排便功能的作用。方法将1998年1月至2000年12月作低前切除的连续67例中下段直肠癌患者根据重建消化道的方法分为2组,第1组(34例)行传统的结肠断端与直肠肛管直接端端吻合(直吻组);第2组(33例)断端结肠制成5～6cm的J型贮袋并与直肠肛管行端侧吻合(袋吻组)。分别于术后1、3、6、9个月和1年、1年半对排便功能进行评估,比较两组的手术并发症和排便功能指标。结果直吻组和袋吻组发生吻合口狭窄分别为3例和1例,直吻组术后出血1例,两组均无吻合口瘘和死亡病例。直吻组和袋吻组术后局部复发分别为4例和3例,直吻组术后肝转移1例。直吻组和袋吻组的日平均大便次数:术后6个月分别为5和2次(P<0.001),术后1年分别为3和1次(P<0.05),术后1年半均为2次(P>0.05)。袋吻组的定性排便控制能力和直肠测压指标均优于直吻组。结论中下段直肠癌低前切除结肠J型贮袋直肠肛管吻合术不增加手术并发症,在术后第1年内有明显改善排便功能的作用。

Objective To evaluate the effect of J pouch coloanal anastomosis after low anterior resection for mid or low rectal cancer on improving the bowel function and clinical outcomes. Methods A prospective randomized trail was made. Between January 1998 and december 2000, 67 consecutive patients undergoing low anterior resection were divided into two groups based on the reconstruction of intestinal continuity: traditional straight coloanal anastomosis (straight group,n=34) or 5 cm colonic J pouch (J pouch group, n=33). Patients were followed up and evaluated at 1,3,6,9,12 and 18 months postoperatively. Both groups were compared in surgical complications and bowel function.Results These two groups were well matched for gender, age, histologic stage. Three and one anastomotic strictures related to the technique were observed in straight group and J pouch group respectively. There was one postoperative bleeding in straight group. No anastomotic leakage and postoperative death were found in these two groups. Recurrenle occurred in four cases in straight group and three cases in J pouch group respectively.Patients with colonic J pouch anal anastomosis displayed significantly better function in terms of frequency of defecation per 24 hours postoperatively (6 months, 5 vs.2; P< 0 001; 12 months, 3 vs.1; P< 0 05; 18 months, 2 vs.2 P >0 05). Colonic J pouch anastomosis resulted in better bowel movement and anorectal manometric findings than traditional straight coloanal anastomosis. Conclusion Colonic J pouch anastomosis after low anterior resection can significantly improve the bowel function without increasing complication rate.