结肠肛管吻合术治疗低位直肠癌近期肛门功能变化及远期疗效的临床研究

A clinical study on changes of short-term anal function and long-term efficacy of coloanal anastomosis in treating low rectal carcinoma

目的研究结肠肛管吻合术治疗低位直肠癌近期肛门功能变化及远期疗效。方法选择2012年6月至2013年8月在我院接受保肛根治术的112例患者为研究对象。随机分为观察组与对照组,每组56例。两组均遵循全直肠系膜切除(TME)原则,观察组采用结肠肛管吻合术,对照组采用双吻合器吻合术。比较两组手术时间、术中出血量和肠动力恢复时间,采用肛门直肠测压仪分别测量两组手术前、术后1个月肛管静息压(ARP)、肠管最大收缩压(MSP)、直肠初感容量(FP)直肠顺应性(RC),经随访和复诊了解两组术后1年肛肠功能恢复、并发症发生情况。结果两组患者手术时间、术中出血量、肠动力恢复时间均无明显差异(P>0.05);观察组术后1个月的ARP、MSP、FP、RC值分别为(21.56±2.68)mmHg、(119.33±15.49)mmHg、(20.86±4.75)mL、(2.68±0.37)mL/mmHg,均明显高于对照组(19.28±2.35)mmHg、(112.34±13.47)mmHg、(17.33±4.19)mL、(1.97±0.21)mL/mmHg(P<0.05);观察组术后1年时肛肠功能恢复优良率为66.07%,显著高于对照组46.43%(P<0.05);观察组术后1年内并发症发生率为3.57%,较对照组12.50%明显降低(P<0.05)。结论以结肠肛管吻合术治疗低位直肠癌,可有效保留患者肛肠功能,并降低并发症发生率,是安全有效的治疗方式。

Objective To study changes of short-term anal function and long-term efficacy of coloanal anastomosis in treating low rectal carcinoma. Methods 112 patients who received anus-preserving radical resection in our hospital from June 2012 to August 2013 were selected as the research objects. They were divided by random number table into the observation group and the control group （each 56 cases）. Two groups all followed the prin- ciple of total mesorectal excision （TME）, the observation group received coloanal anastomosis, the control group received double-stapling anastomosis. Operation time, intraoperative blood loss and gastrointestinal dynamic recovery time were compared between the two groups, anal resting pressure （ARP）, maximum systolic pressure （MSP）, volume for rectal sensation （FP） rectal compliance （RC） in the two groups were measured by anorectal pressure measuring instrument before the operation and 1 month after the operation, anorectal function recovery 1 year after the operation, complications in the two groups were understood by the follow-up or subsequent visit. Results There was no significant difference in operation time, intraoperative blood loss and gastrointestinal dynamic recovery time between the two groups （P〉0.05） ; ARP, MSP, FP and RC in the observation group 1 month after the operation were （21.56±2.68）mmHg, （119.33±18.49）mmHg, （20.86±4.75）ml and （2.68±0.37）ml/mmHg respectively, which were significantly higher than the control group [（19.28±2.35）mmHg, （112.34±13.47） mmHg, （17.33±4.19）ml and （1.97±0.21）ml/mmHg] （P〈0.05）; excellent and good rate of anorectal function recovery 1 year after the operation in the observation group was 66.07%, which was significantly higher than the control group （46.43%） （P〈0.05） ; complication rate of the observation group in 1 year after the operation was 3.57%, which was reduced significantly than the control group （12.50%） （P〈0.05）. Conclusion Treating low rectal carcinoma by coloanal anastomosis can retain patients＇ anorectal function effectively, reduce complication rate, it is a safe and effective treatment.