不同肠道重建术对直肠癌患者肛门功能的影响

Effect of different intestinal reconstruction of anal function in rectal cancer

目的探讨直肠癌患者三种肠道重建术对肛门功能的不同影响。方法将159例低位直肠癌患者分为直接吻合组(n=52)、结袋组(n=54)和J型袋组(n=53)。三组患者均行全直肠结肠系膜切除术,手术后吻合组患者行直接吻合术,结袋组患者行结肠袋成形术,J型袋组患者行J型贮袋手术。观察三组患者手术成功率,术后对三组患者均分别随访3个月、6个月及12个月,观察患者肛门功能的主观感受、肛管直肠压力水平和术后并发症发生率。结果三组患者术后肠道重建成功率及大便不能完全排空率差异无统计学意义(P>0.05)。术后3个月、6个月、12个月,结袋组、J型袋组患者肛门功能主观感受评分高于吻合组患者(P均<0.01);结袋组与J型袋组患者24 h排便次数、不能区分排便与排气发生率均显著少于吻合组(P均<0.05)。三组患者术后并发症发生率比较差异无统计学意义(P>0.05)。术后3、6、12个月,结袋组和J袋组静息压和最大耐受容量高于直接吻合组,术后12个月,结袋组和J袋组最大收缩压和顺应性均高于直接吻合组,差异均有统计学意义(P<0.01)。三组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。结论低位直肠癌患者全直肠结肠系膜切除术后,对患者行直接吻合对其肛门功能的影响最大,而对患者采用结肠袋形成术及J型贮袋手术则影响较小,因此临床上可以根据患者病情行最佳肠道重建术,最大程度保留患者肛门功能。

Objective To investigate the effect of different intestinal reconstruction of anal function in rectal cancer. Methods 159 pa-tients were treated with mesorectal excision of the whole colon and rectum. Then they were divided into three groups：anastomosis group（n = 52, treated with direct anastomosis）,colon forming group（n = 54,treated with colon shaping marsupialization）and J pouch group（n = 53,patients were treated with J pouch surgery）. The success rate was compared and the anal function of all the patients was observed after 3 months,6 months and 12 months. Results The patients of the three groups have no difference（ P ﹥ 0. 05）. After 3 months,6 months and 12 months,the subjec-tive scores of anal function in colon forming group and J pouch group were higher than that in anastomosis group（ P ﹤ 0. 01）. The 24 h defecation of patients in colon forming group and J pouch group were less than that in anastomosis group（ P ﹤ 0. 01）. There were no significant difference of the rate of complication between the three groups（ P ﹥ 0. 05）. Anal resting pressure and maximum capacity in colon forming group and J pouch group 3,6,12 months after the operation were all higher than those in anastomosis group,maximum systolic pressure and elasticity in colon form-ing group and Jpouch group 12 months after the operation were all higher than those in anastomosis group,the differences were statistically signifi-cant（ P ﹤ 0. 01）. The incidence of postoperative complications in three groups had no statistically significant difference（ P ﹥ 0. 05）. Conclu-sion After total mesorectal excision of patents with low rectal cancer,direct anastomosis has the most remarkable influence of anal function com-pared with colon forming bags and J pouch surgery. The best method of enteric reconstruction should be applied to make the greatest extent for pres-ervation of anal function.