直肠癌低位前切除术肠道重建不同吻合方式对肛门直肠功能变化的影响  

Effects of different anastomotic methods on intestinal reconstruction in low anterior resection of rectal cancer on anorectal function

作　　者：田军军[1] 何韵 彭礼忠 TIAN Junjun;HE Yun;PENG Lizhong(Department of General Surgery,Hubei Hospital of Traditional Chinese Medicine,Wuhan 430074,China)

机构地区：[1]湖北省中医院普外科,湖北武汉430074

出　　处：《中国肿瘤外科杂志》2023年第2期153-157,共5页Chinese Journal of Surgical Oncology

摘　　要：目的探讨直肠癌低位前切除术肠道重建不同吻合方式对肛门直肠功能变化的影响。方法选取2018年7月至2021年7月湖北省中医院普外科收治的141例低位直肠癌患者为研究对象,均行直肠癌低位前切除术治疗。根据肠道重建不同吻合方式分为直接吻合组(45例)、J型袋组(49例)和结袋组(47例),分别采用直接吻合术、J型贮袋术、结肠成形袋术。术后均随访1年,比较三组手术结果。观察术后3、6、12个月三组患者术后肛门直肠功能变化(排便情况、排便主观感受、肛门直肠压力)情况,并对比三组术后并发症情况。结果三组患者肠道重建吻合成功率、术后并发症比较,差异无统计学意义(P>0.05)。三组患者术后3、6、12个月大便不能完全排空发生率比较差异无统计学意义(P>0.05),J型袋组和结袋组患者术后3、6、12个月不能区分排气与排便的发生率、24 h排便次数均低于直接吻合组(P<0.05)。J型袋组和结袋组患者术后3、6、12个月排便评分、最大耐受容量、静息压均高于直接吻合组(P<0.05)。J型袋组和结袋组患者术后12个月最大收缩压、顺应性均高于直接吻合组(P<0.05),J型袋组和结袋组患者术后3、6、12个月肛门直肠功能指标比较差异无统计学意义(P>0.05)。结论低位直肠癌患者经手术根治切除后,肠道重建采用直接吻合术影响患者肛门直肠功能,而J型贮袋术和结肠成形袋术对患者肛门功能影响接近,临床可根据患者具体生理情况行肠道重建术式,以期最大程度的保留患者肛门功能。Objective To investigate the effects of different anastomotic methods on the changes of anorectal function in patients with bowel reconstruction after low anterior resection for rectal cancer.Methods A total of 141 patients with low rectal cancer who underwent low anterior resection in Hubei Hospital of Traditional Chinese Medicine from July 2018 to July 2021 were selected were divided into anastomosis group(45 cases),J-shaped pouch group(49 cases)and colonic pouch group(47 cases)according to different anastomotic methods of intestinal reconstruction,respectively.All patients were followed up for 1 year after operation,and the surgical results of the three groups were compared.The changes of anorectal function(defecation situation,subjective feeling of defecation,anorectal pressure)were observed in the three groups after 3,6 and 12 months of operation.The postoperative complications among the three groups were compared as well.Results There was no difference on the success rates of intestinal reconstruction and anastomosis and postoperative complications among the three groups(P>0.05).There was no difference in the incidence of incomplete bowel emptying among the three groups after 3,6 and 12 months of operation(P>0.05).The incidence of inability to distinguish between gas and defecation,and the number of defecation in 24 h in the J-shaped pouch group and colonic pouch group were lower than those in the anastomosis group after 3,6 and 12 months of operation(P<0.05).The defecation score,maximum tolerated volume and resting pressure of patients in J-shaped pouch group and colonic pouch group were higher than those in anastomosis group after 3,6 and 12 months of operation(P<0.05).The maximum systolic blood pressure and compliance at 12 months after operation in J-shaped pouch and colonic pouch group were higher than those in anastomosis group(P<0.05).There was no difference in the anorectal function indexes between the J-shaped pouch and colonic pouch group at 3,6,and 12 months after operation(P>0.05).Conclusions In

关 键 词：低位直肠癌 直肠癌低位前切除术 直接吻合术 J型贮袋术 结肠成形袋术 L肛门直肠功能 

分 类 号：R735.37[医药卫生—肿瘤]