改良腹腔镜低位直肠吻合方法对肛门直肠功能的影响  

Study on the effects of modified laparoscopic low rectal anastomosis on anal -rectal function

作　　者：谢志远 张亮[2] 龚龙波[2] 张文涛 林浩 刘入铭[2] 张才华[2] 滕雪 吕孝鹏[2] 符伟 

机构地区：[1]徐州医科大学研究生学院,江苏徐州221004 [2]徐州市中心医院胃肠外科,江苏徐州221009 [3]徐州医科大学附属医院胃肠外科,江苏徐州221002

出　　处：《徐州医科大学学报》2017年第10期631-635,共5页Journal of Xuzhou Medical University

基　　金：国家卫生计生委医药卫生科技发展项目（W2014RQ38）;徐州市科技项目（KC15SH062）

摘　　要：目的探讨改良腹腔镜低位直肠吻合方法对术后肛门直肠功能的影响。方法回顾性收集2015年1月—2016年12月间就诊于徐州市中心医院胃肠外科并行腹腔镜直肠癌低位前切除术患者74例的临床资料。A组36例行腹腔镜直肠癌前切除术改良吻合方法，B组38例行腹腔镜直肠癌前切除术传统双吻合方法。对比2组患者的年龄、性别、肿瘤距齿状线距离、TNM分期、术前Wexner评分的差异，统计远切缘距离、吻合口高度、远端吻合环长度；并通过电话和门诊随访，采用LARS评分及Wexner评分评价肛门直肠功能。结果2组患者的年龄、性别、肿瘤距齿状线距离、TNM分期、术前Wexner评分的差异无统计学意义；改良吻合术组的吻合口高度大于传统吻合组[（3．50±1．03）cm vs（2．87±1．10）cm，P=0．01]，随访Wexner评分，术后3个月（8．61±2．44vs10．11±2．96，P=0．02）、术后6个月（6．36±1．81VS7．55±2．32，P=0．02）改良吻合组统计值均优于传统吻合组。改良吻合组与常规吻合组的LARS评分术后3个月（P=0．04）、6个月（P=0．02）的符合度差异具有统计学意义。结论腹腔镜低位直肠癌改良吻合术能提高吻合口高度，减少括约肌损伤，增加对术后肛门直肠功能的保护。Objective To explore the effects of the modified laparoscopic low rectal anastomosis on anal - rectal functions. Methods A total of 74 patients who were admitted into our department from January 2015 to December 2016 and received laparoscopie low anterior resection were enrolled before retrospective analysis. Patients in Group A （ n = 36） were subject to laparoscopic anterior resection of prostate cancer through modified gastrointestinal anastomosis, while those in Group B （ n = 38 ） were provided with the traditional double anastomotic method of laparoscopic low anterior resection. Both groups were compared for age, gender, the distance from the tumor to the dentate line, TNM staging, and Wexner grading before surgery. Meanwhile, the distal margin distance, anastomotic height, and the length of distal anastomotic ring were recorded. The anal - rectal functions were evaluated through telephones and follow - up visits using the least angle regression scores （LARS） and Wexner scores. Results There was no statistical significance in age, gender, the distance from the tumor to the dentate line, TNM staging, and Wexner grading before surgery between the both groups （P 〉 0.05 ）. The modification group showed higher anastomotic stoma height than the traditional anastomosis group （3.50 ± 1.03 vs 2.87 ± 1.10, P =0.01 ）. Compared with the traditional group, the modification group produced better Wexner scores 3 months after surgery （8.61 ±2.44 vs 10.11 ±2.96, P =0.02） and 6 months after surgery （6.36 ± 1.81 vs 7.55 ± 2.32, P = 0.02）. Statistical difference was found as to LARS scores between the traditional and modification groups 3 months after surgery （ P = 0.04 ） and 6 months after surgery （ P = 0.02 ）. Conclusions The modified laparoscopie anastomosis for low rectal carcinoma can improve anastomotic stoma height, reduce sphincter damage, and protect anal -rectal function after surgery.

关 键 词：低位直肠癌 腹腔镜 肛门直肠功能 

分 类 号：R615[医药卫生—外科学]