直肠癌低位前切除术中不同肠道重建方式对术后功能保护的研究进展

Research progress of different bowel reconstructions for postoperative functional protection during low anterior resections of rectal cancer

在直肠癌低位前切除手术中,最常用的4种肠道重建方式为结肠肛管端端吻合(SCA)、结肠J型储袋吻合术(CJP)、结肠成形术(TCP)以及结肠肛管端侧吻合术(SEA)。不同的肠道重建方式对患者术后的排粪功能、泌尿功能和性功能影响不一。SCA是最为传统的方式;CJP是研究较多,发展较为成熟的重建方式,但是最近的研究显示,CJP并发症发生率最高,临床应用时要谨慎;SEA在近期和远期的排粪功能、排尿功能和性功能均不劣于CJP和SCA,手术安全性也值得信赖,有望成为SCA和CJP的替代术式。而关于TCP的研究最少,但是目前有一些相关的临床试验正在开展,其结果值得期待。肠道重建方式的改良与创新为直肠癌患者更好的功能预后提供了光明的前景。

Straight coloanal anastomosis(SCA),colonic J-pouch anastomosis(CJP),transverse coloplasty pouch anastomosis(TCP),and side-to-end anastomosis(SEA)are the most commonly used procedures of bowel reconstructions in the low anterior resections(LAR)of rectal cancer.Different bowel reconstruction procedures greatly affect postoperative bowel function,urinary function and sexual function.SCA is the most traditional procedure.CJP has been studied extensively and well-developed reconstruction method;however,recent studies have shown that CJP has the highest morbidity of complications,so the clinical application of CJP is limited.SEA is not inferior to CJP and SCA in the short-term and long-term defecation function,urination function,and sexual function,with reliable operational safety,so it is expected to become an alternative to SCA and CJP.The research on TCP is lacking,but there are some related clinical trials currently underway,and the results are worth expecting.The improvement and innovation of bowel reconstructions provide a bright prospect for better functional prognosis in patients with rectal cancer.