乙状结肠成形术在中低位直肠癌前切除中的应用价值  

Application of sigmoid coloplasty after resection of middle or low rectal cancer

作　　者：梁建伟[1] 周志祥[1] 刘骞[1] 毕建军[1] 田艳涛[1] 王征[1] 赵平[1] 

机构地区：[1]中国医学科学院肿瘤医院腹部外科,北京100021

出　　处：《中华消化外科杂志》2009年第2期137-139,共3页Chinese Journal of Digestive Surgery

摘　　要：目的探讨乙状结肠成形术在中低位直肠癌前切除中的可行性，并评估其对直肠癌患者术后排便功能的作用。方法选择中国医学科学院肿瘤医院2007年1月至2008年1月收治的43例中下段直肠癌（肿瘤下缘距肛缘〈8cm）的患者于直肠癌前切除术后行乙状结肠成形术（观察组），同期收治的43例中下段直肠癌患者行结肠J型贮袋重建（对照组）。采用t检验、Χ^2检验或Fisher确切概率法比较两种术式的可行性、安全性及术后患者排便功能。结果观察组患者全部完成壶腹重建，对照组4例患者贮袋重建失败。两组各有3例患者行临时性横结肠造口术。观察组术后并发症发生率为7％（3／43），对照组术后并发症发生率为9％（4／43），两组比较差异无统计学意义（Χ^2=0．282，P〉0．05）。术后4个月时，24h排便次数观察组为（2．0±1．5）次，对照组为（2．5±1．0）次，两组比较差异无统计学意义（Χ^2=1．242，P〉0．05）。大便失禁评分观察组为（1．7±0．7）分，对照组为（1．6±0．8）分，两组比较差异无统计学意义（t=0．285，P〉0．05）。结论乙状结肠成形术与结肠J型贮袋重建在改善患者排便功能方面作用相似。乙状结肠成形术是一种简便、安全和有效的手术方法。Objective To investigate the feasibility of sigmoid coloplasty for patients after resection of middle or low rectal carcinoma, and to evaluate the defecation function after the operation. Methods Forty-three patients with middle or low rectal cancer who had been admitted to the cancer Hospital of the Chinese Academy of Medical Sciences from January 2007 to January 2008 received sigmoid coloplasty after rectal carcinoma resection （treatment group） , and another 43 patients who had been admitted during the same period received colonic J pouch reconstruction （control group ）. The feasibility and safety of the 2 surgical procedures and postoperative defecation function were assessed. All data were processed by t test, ehi-square test or Fisher exact probability. Results The sigmoid coloplasty was successfully performed in all patients in treatment group, while the recon- struction of the J pouch failed in 4 patients in the control group. Three patients in each group underwent temporary transverse colostomy. The incidences of postoperative complications in treatment group and control group were 7% （3/43） and 9% （4/43）, respectively, with no statistical difference between the 2 groups （Χ^2 = 0. 282, P 〉 0.05 ）. The median frequency of defecation in treatment group was 2.0 ± 1.5 per 24 hours, which was significantly less than 2.5 ± 1.0 in control group （ Χ^2 = 1. 242, P 〉 0.05 ）. The fecal incontinence scores in treatment group and control group were 1.7 ± 0.7 and 1.6 ±0.8, respectively, with no statistical difference between the 2 groups （ t = 0. 285, P 〉 0.05 ）. Conclusion Sigmoid coloplasty has similar benefits to colonic J pouch reconstruction, while sigmoid coloplasty is relatively feasible, effective and safe for low colorectal or coloanal anastomosis.

关 键 词：直肠肿瘤 乙状结肠成形术 结肠J型贮袋 

分 类 号：R735.37[医药卫生—肿瘤] R656.9[医药卫生—临床医学]