经肛门结肠直肠套入式吻合对腹腔镜低位直肠癌保肛术患者肠道功能的影响分析

Effect of trans-anal colorectal telescopic anastomosis on intestinal function in patients with low rectal cancer treated with laparoscopic sphincter-preserving surgery

目的探讨腹腔镜低位直肠癌保肛术中经肛门结肠直肠套入式吻合对患者肠道功能的影响。方法回顾性分析2016年1月至2017年12月于江油市人民医院接受腹腔镜低位直肠癌保肛术的76例患者资料,以其中39例采用经肛门结肠肛管吻合术(改良Parks手术)为对照组、37例采用经肛门结肠直肠套入式吻合方案治疗者为观察组。对比两组手术效果、术后并发症情况、术前及术后6个月时肠道功能指标。结果两组患者手术情况、术中出血量、淋巴结清扫数目、盆腔引流管拔除时间、术后住院时间、术后并发症发生率比较,差异均无统计学意义(均P> 0.05)。两组患者术前美国纽约纪念斯隆-凯特林癌症中心(MSKCC)肠道功能问卷得分、肛管静息压、肛管最大收缩压、肛管最大收缩时间、肛管直肠抑制反射阳性率比较,差异均无统计学意义(均P> 0.05)。术后6个月,观察组MSKCC肠道问卷总分、便频、便急及排便感觉异常得分、肛管静息压、肛管最大收缩压均高于对照组,差异均有统计学意义(均P <0.05)。结论腹腔镜低位直肠癌保肛术中经肛门结肠直肠套入式吻合能够有效保护患者肠道功能,具有良好的临床应用价值。

Objectives To investigate the effect of trans-anal colorectal telescopic anastomosis on intestinal function in patients with low rectal cancer treated with laparoscopic sphincter-preserving surgery. Methods This was a retrospective analysis of 76 patients who received laparoscopic sphincter-preserving surgery at Jiangyou People’s Hospital between January 2016 and December 2017. 39 patients received transanal coloanal anastomosis (revised Parks surgery) and they were the control group. 37 patients received transanal colorectal telescopic anastomosis and they were the treatment group. Effectiveness of the surgery, postoperative complications, and intestinal function before and 6 months after surgery were compared between the two groups. Results There was no significant difference in surgical condition, amount of intraoperative blood loss, number of dissected lymph nodes, time to extubation of pelvic drainage, postoperative duration of hospitalization, and incidence of postoperative complications (P > 0.05). There was no significant difference between the two groups in intestinal function scores measured by the Memorial Sloan-Kettering Cancer Center (MSKCC) questionnaire, anal resting pressure, anal maximum systolic pressure, maximum systolic time, and positive rate of anal-rectal inhibitory reflex before surgery (P > 0.05). There was significant between-group difference in MSKCC intestinal function total scores, the scores of frequent and hasty defecation, the scores of abnormal defecation sensation, anal resting pressure, and anal maximum systolic pressure (P < 0.05). Conclusion Trans-anal colorectal telescopic anastomosis could effectively protect patients’intestinal function in treating low rectal cancer treated with laparoscopic sphincter-preserving surgery. It had a certain value in clinical management.