直肠癌前切除、结肠“J”型储袋对术后排便功能的影响.DOCVIP

临床医学论文-直肠癌前切除、结肠“J”型储袋对术后排便功能的影响 【摘要】? 目的 为探讨直肠癌行低位前切除术后应用结肠“J”型储袋行直肠或肛管吻合能否改善患者的排便功能。方法 对2000年1月至2001年1月间连续行低位前切除术的72例中、下段直肠癌患者行回顾性分析。根据吻合方式分为两组：“J”型储袋组，共33例;直接吻合组，共37例。分别于术后1、3、6及12个月，对手术并发症及排便功能行比较性研究。结果 发现两组均无手术死亡及术后出血病例。直吻组发生吻合口瘘2例;储袋组及直肠组术后吻合口狭窄分别为2例及1例;局部复发者各为3例;肝转移分别为2例及3例。“J”型储袋组较直接吻合组患者术后6个月及12个月之日排便次数及夜间排便人数比率均明显减少(7次vs 3次，P0.05;3次vs 1次，P0.05)，(64% vs 31%,P0.05;30% vs 3.9%, P0.05 )。前者大便失禁综合评分显著优于后者(8 vs 2，P0.05;5.2 vs 1.5，P0.05)。结论 结果表明直肠癌行低位前切除术后，应用“J”型储袋行直肠或肛管吻合，不增加手术并发症，且在术后1年内，可以在某些方面改善患者排便功能。 【关键词】? 中、下段直肠癌; 低位前切除术; 结肠“J”型储袋; 排便功能 　　[Abstract] Objective To investigate the effect of colonic Jpouch anastomosis on bowel function after low anterior resection(LAR) in patients with mid or low rectal cancer. Methods A retrospective review was made in 72 consecutive patients underwent LAR between January 2000 and January 2001. Thirtythree patients in Jpouch group had a stapled colonic Jpouch coloanal anastomosis and 39 in nonpouch group had a stapled coloanal anastomosis. The patients were followed up and evaluated at postoperative 1, 3, 6 and 12 months. Results No surgical death and post operative bleeding were found in both groups. Two cases in nonpouch group had anastomotic leakages. Anastomotic strictures occurred in 2 cases in Jpouch group and 1 in nonpouch group. Three cases of local recurrences were found in each group. Liver metastases developed in 2 cases in Jpouch group and 3 in nonpouch group. At postoperative 6 and 12 months， there was a significant reduction of frequency of bowel movements per 24h (7 vs 3, P0.05;3 vs1, P0.05 )and nocturnal movements in Jpouch group than in nonpouch group (64% vs 31%, P0.05; 30% vs 39%, P0.05). The incontinence score in Jpouch group were superior to nonpouch group (8 vs 2, P0.05; 5.2 vs 1.5, P0.05). Conclusion Colonic Jpouch anastomosis after low anterior resection can significantly improve the bowel function in some aspects without increasing complication rates. 　　[Key words] Mid or low rectal ca