结肠贮袋改善直肠癌术后排便功能的临床观察  

The Effect of Colonic Pouch Construction on Improving Defecation after Resection for Rectal Carcinoma

作　　者：于滨[1] 李永涛[1] 于跃明[1] 

机构地区：[1]河北医科大学第四医院外二科,石家庄市050011

出　　处：《中国肿瘤临床》2007年第23期1330-1332,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:评价直肠癌低位前切除术后采用结肠贮袋吻合对术后排便功能的影响。方法:将1999年1月至2003年10月行低位前切除术的直肠癌患者70例随机分为两组,一组采用结肠J型贮袋吻合术(colon J-pouch anastomosis,CAP)30例,制作J型贮袋长约5cm。另一组采用结肠、直肠(肛管)端端吻合术(end to end anastomosis,EEA)40例,通过术后6、9、12、18个月随访比较两组直肠测压结果与排便功能。结果:术后并发症中,两组均无死亡病例、无临时性造口病例,无吻合口瘘发生,CAP组和EEA组分别发生吻合口狭窄1例和2例,术后肠梗阻CAP组1例,CAP组9～18个月复发1例。术后6个月时直肠测压结果及排便功能CAP组优于EEA组,差异有统计学意义(P<0.05);术后9个月时两组各项指标比较,仅大便失禁评分CAP组优于EEA组,差异有显著性(P<0.05),其他各项指标比较均无明显差异(P>0.05);术后12个月以上两组上述指标基本正常,两组比较,差异无统计学意义(P>0.05)。结论:对于中下段直肠癌在行根治性手术的前提下采用J型贮袋吻合术可以明显改善术后9个月内排便功能,并且不增加术后并发症。Objective： To evaluate the effect of colonic pouch anastomosis on improving defecation after low anterior resection for rectal carcinoma. Methods： From 1999 to 2003, 70 patients who underwent low anterior resection were divided into two groups： 5 cm colon J-pouch anastomosis group （CAP group, n=30）, and end-to-end anastomosis group（EEA group, n=40）. The rectal pressure and defecation of the patients were compared at 6, 9, 12 and 18 months after surgery. Results： Postoperative death, temporary colostomy and anastomosis leakage were not seen in either group. Anastomotic stricture was observed in one patient in the CAP group and in two patients in the EEA group. Postoperative ileus occurred in one patient in the CAP group and it recurred 9 to 18 months after surgery. The rectal pressure anti defecation of the CAP group were better than those of the EEA group at 6 months after surgery, with a significant difference （P〈0.05）. The encopresis seore of the CAP group was better than that of the EEA group at the 9th month postoperatively（P〈0.05） and no significant difference was fot, nd in othcr indices between the two groups. Twelve months after the surgery, the above indices in both groups decreased into the normal range, without a significant difference between the two groups （P〉 0.05）. Conclusion： For patients with low anterior resection of middle and low rectal carcinoma, J- pouch coloanal anastomosis can improve postoperative defe, cation within 9 months.

关 键 词：直肠癌 结肠贮袋 排便功能 

分 类 号：R735.37[医药卫生—肿瘤]