结肠J型贮袋在高龄低位直肠癌患者保肛手术后控便功能中的作用  

Bowel control effect in elderly low rectal cancer patients after colonic J-pouch anus-retained operation

作　　者：鲁兵[1] 傅传刚[2] 刘连杰[2] 刘玉祥[1] 陈勇[1] 周坤 王振宜[3] 

机构地区：[1]武警上海总队医院普外科,上海市201103 [2]第二军医大学附属长海医院肛肠外科 [3]上海中医药大学附属岳阳医院肛肠外科 [4]不详

出　　处：《中华老年多器官疾病杂志》2008年第3期182-185,189,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的评价采用J型贮袋在高龄患者保肛手术后改善排便机能中的价值。方法选取2002年2月至2003年8月诊治的39例高龄(≥75岁)低位直肠癌患者。按手术方式分成两组,传统的结肠断端与直肠肛管直接端端吻合组(直吻组),结肠J型贮袋与直肠肛管行端侧吻合组(贮袋组),对保肛手术后控便情况进行调查研究。结果术后排便次数正常的时间:贮袋组优于直吻组(P<0.01)。术后3个月、半年,贮袋组平均排便次数明显少于直吻组(P<0.05);延缓排便控制能力、失禁综合评分、区分排便排气能力等指标均优于直吻组(P<0.05);但术后1年及1年半,两组控便能力差异无显著性(P>0.05)。贮袋组直肠测压值优于直吻组。术后控便情况满意率贮袋组高于直吻组。采用贮袋吻合术后便秘的发生率高于直接吻合术(P<0.01)。结论(1)高龄不是结肠贮袋直肠肛管吻合术的禁忌证;(2)采用结肠贮袋直肠肛管吻合术能够明显改善高龄患者术后1年内控便功能。Objective To evaluate the bowel control effect of J-pouch coloanal anastomosis of the anus-retained operation in elderly low rectal cancer patients. Methods Thirty-nine elderly low rectal cancer inpatients（≥75 years） in our hospital from Feb. 2002 to Aug. 2003 were included. They were divided into direct anastomosis group and colonic J-pouch anastomosis group. The bowel control effect of patients were investigated. Results The colonic J- pouch anastomosis group had improved defecation recovery time compared with that in the direct anastomosis group after surgery（P〈0.01）. Compared with direct anastomonsis group, patients with colonic J-pouch anastomosis displayed significantly better bowel control after 3 months or half year（P〈0.05）, but did not display significant difference after 1 year（P〉0.05）. Patients in the colonic J-pouch anastomosis group had better rectal pressure and higher satisfaction rate but had higher rate of constipation than that in the direct anastomosis group after operation. Conclusion （1） Advanced age （≥75 years） should not be the contraindication of colonic J-pouchanal anastomosis. （2） For these patients using the colonic J-pouchanal anastomosis can improve bowel control function obviously within 1 year.

关 键 词：低位直肠癌 保肛手术 结肠J型贮袋 年龄因素 

分 类 号：R735.37[医药卫生—肿瘤] R657.1[医药卫生—临床医学]