PURPOSE: Functional disturbances are common after anterior resection for rectal cancer. This study was designed to compare functional and physiologic outcome after low anterior resection and total mesorectal excision ...PURPOSE: Functional disturbances are common after anterior resection for rectal cancer. This study was designed to compare functional and physiologic outcome after low anterior resection and total mesorectal excision with a colonic J-pouch or a sideto-end anastomosis. METHODS: Functional and physiologic variables were analyzed in patients randomized to a J-pouch (n = 36) or side-to-end anastomosis (n = 35). Postoperative functional outcome was investigated with questionnaires. Anorectal manometry was performed preoperatively and at six months, one year, and two years postoperatively. RESULTS: There was no statistical difference in functional outcome between groups at two years. Maximum neorectal volume increased in both groups but was approximately 40 percent greater at two years in pouches compared with the side-to-end anastomosis. Anal sphincter pressures volumes were halved postoperatively and did not recover during follow-up of two years. Male gender, low anastomotic level, pelvic sepsis, and the postoperative decrease of sphincter pressures were independent factors for more incontinence symptoms. CONCLUSIONS: Colonic J-pouch and side-to-end anastomosis gives comparable functional results two years after low anterior resection. Neorectal volume had no detectable influence on function. There was a pronounced and sustained postoperative decrease in sphincter pressures.展开更多
PURPOSE: Colon pouch reconstruction after total mesorectal excision is functionally superior to straight colorectal/anal anastomosis. In the long-term, stool evacuation difficulties could jeopardize the functional ben...PURPOSE: Colon pouch reconstruction after total mesorectal excision is functionally superior to straight colorectal/anal anastomosis. In the long-term, stool evacuation difficulties could jeopardize the functional benefit. The transverse coloplasty pouch presents an alternative to the standard J-pouch. This study was designed to analyze functional outcome and defecography findings after total mesorectal excision and transverse coloplasty pouch reconstruction. METHODS: Thi rty consecutive patients with cancer of the middle and lower third of the rectum underwent a total mesorectal excision and were examined in a prospective study. In all patients, reconstruction was performed with a transverse coloplasty pouch. Pouch and anastomosis were checked by Gastrografinenema postoperatively. Patients were examined within eight months by means of defecography, manometry, pouch volumetry, and a standardized continence questionnaire. RESULTS: Total mesorectal excision with transverse coloplasty pouch anastomosis was performed successfully in all patients. Symptomatic anastomotic leakage was observed in 2 of 30 patients and the radiologic leak rate was 4 of 30. All patients evacuated the pouch completely; none needed enemas or suppositories to facilitate defecation. Twenty five of 27 patients had a maximum of three bowel movements per day, and all patients were continent for solid stools. Patients with abnormal findings on defecography proved more likely to have anal dysfunction. CONCLUSIONS: Transverse coloplasty pouch reconstruction after total mesorectal excision leads to good functional results and is not associated with stool evacuation problems. Urgency and incontinence correlate rather with impaired pelvic floor movement than with pouch size or anal sphincter tonus.展开更多
小袋纤毛虫病是一种人畜共患寄生虫病。本研究从浙江地区病猪盲肠内分离到了一株结肠小袋纤毛虫,通过RPMI1640培养基对其进行了体外培养,结肠小袋纤毛虫在28℃和37℃均能良好生长,在培养后第5天和第4天分别达到高峰值,虫体密度分别为1.6...小袋纤毛虫病是一种人畜共患寄生虫病。本研究从浙江地区病猪盲肠内分离到了一株结肠小袋纤毛虫,通过RPMI1640培养基对其进行了体外培养,结肠小袋纤毛虫在28℃和37℃均能良好生长,在培养后第5天和第4天分别达到高峰值,虫体密度分别为1.60×104和2.31×104个·m L-1。显微镜下滋养体胞口、胞肛和食物泡结构明显,DAPI染色后大核明显呈哑铃型,且滋养体有大小差别明显的2种类型。18S r RNA基因PCR扩增、测序和聚类分析结果显示,猪源结肠小袋纤毛虫分离株存在2条明显不同的18S r RNA基因序列,序列间趋异性为0.6%,且该分离株序列与国外分离株间存在显著差异,在进化树上形成一独立的亚枝。在高倍显微镜下,滋养体内常见有许多生物活动,种类不明,16S r RNA基因PCR扩增到3条未知细菌序列,未知细菌16S r RNA基因序列与结肠小袋纤毛虫内微生物间的确切关系有待研究。展开更多
文摘PURPOSE: Functional disturbances are common after anterior resection for rectal cancer. This study was designed to compare functional and physiologic outcome after low anterior resection and total mesorectal excision with a colonic J-pouch or a sideto-end anastomosis. METHODS: Functional and physiologic variables were analyzed in patients randomized to a J-pouch (n = 36) or side-to-end anastomosis (n = 35). Postoperative functional outcome was investigated with questionnaires. Anorectal manometry was performed preoperatively and at six months, one year, and two years postoperatively. RESULTS: There was no statistical difference in functional outcome between groups at two years. Maximum neorectal volume increased in both groups but was approximately 40 percent greater at two years in pouches compared with the side-to-end anastomosis. Anal sphincter pressures volumes were halved postoperatively and did not recover during follow-up of two years. Male gender, low anastomotic level, pelvic sepsis, and the postoperative decrease of sphincter pressures were independent factors for more incontinence symptoms. CONCLUSIONS: Colonic J-pouch and side-to-end anastomosis gives comparable functional results two years after low anterior resection. Neorectal volume had no detectable influence on function. There was a pronounced and sustained postoperative decrease in sphincter pressures.
文摘PURPOSE: Colon pouch reconstruction after total mesorectal excision is functionally superior to straight colorectal/anal anastomosis. In the long-term, stool evacuation difficulties could jeopardize the functional benefit. The transverse coloplasty pouch presents an alternative to the standard J-pouch. This study was designed to analyze functional outcome and defecography findings after total mesorectal excision and transverse coloplasty pouch reconstruction. METHODS: Thi rty consecutive patients with cancer of the middle and lower third of the rectum underwent a total mesorectal excision and were examined in a prospective study. In all patients, reconstruction was performed with a transverse coloplasty pouch. Pouch and anastomosis were checked by Gastrografinenema postoperatively. Patients were examined within eight months by means of defecography, manometry, pouch volumetry, and a standardized continence questionnaire. RESULTS: Total mesorectal excision with transverse coloplasty pouch anastomosis was performed successfully in all patients. Symptomatic anastomotic leakage was observed in 2 of 30 patients and the radiologic leak rate was 4 of 30. All patients evacuated the pouch completely; none needed enemas or suppositories to facilitate defecation. Twenty five of 27 patients had a maximum of three bowel movements per day, and all patients were continent for solid stools. Patients with abnormal findings on defecography proved more likely to have anal dysfunction. CONCLUSIONS: Transverse coloplasty pouch reconstruction after total mesorectal excision leads to good functional results and is not associated with stool evacuation problems. Urgency and incontinence correlate rather with impaired pelvic floor movement than with pouch size or anal sphincter tonus.
文摘小袋纤毛虫病是一种人畜共患寄生虫病。本研究从浙江地区病猪盲肠内分离到了一株结肠小袋纤毛虫,通过RPMI1640培养基对其进行了体外培养,结肠小袋纤毛虫在28℃和37℃均能良好生长,在培养后第5天和第4天分别达到高峰值,虫体密度分别为1.60×104和2.31×104个·m L-1。显微镜下滋养体胞口、胞肛和食物泡结构明显,DAPI染色后大核明显呈哑铃型,且滋养体有大小差别明显的2种类型。18S r RNA基因PCR扩增、测序和聚类分析结果显示,猪源结肠小袋纤毛虫分离株存在2条明显不同的18S r RNA基因序列,序列间趋异性为0.6%,且该分离株序列与国外分离株间存在显著差异,在进化树上形成一独立的亚枝。在高倍显微镜下,滋养体内常见有许多生物活动,种类不明,16S r RNA基因PCR扩增到3条未知细菌序列,未知细菌16S r RNA基因序列与结肠小袋纤毛虫内微生物间的确切关系有待研究。
