结肠S型贮袋在低位直肠癌根治术超低位吻合术中的应用

目的评价老年低位直肠癌前切除结肠S型贮袋一直肠或肛管吻合对改善排便功能的作用。方法将2004年至2007年收治的老年低位直肠癌患者49例随机分为2组，第1组24例，行传统的结肠断端与直肠肛管直接端端吻合（直吻组）；第2组25例，将断端结肠制成5cm的S型贮袋并与直肠或肛管行端侧吻合（袋吻组）。分别于术后1、3、6、9、12、18个月对排便功能进行评估，比较2组的手术并发症和排便功能指标。结果直吻组和袋吻组术后并发症无明显差异，术后6、12个月，袋吻组平均排便次数明显少于直吻组；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也以袋吻组为优。但术后18个月，2组排便功能已无差别。袋吻组的定性排便控制能力和直肠测压指标均优于直吻组。结论直肠癌低位前切除结肠S型贮袋直肠肛管吻合术不增加手术并发症，在术后第1年内有明显改善老年直肠癌患者排便功能的作用。

The radical surgery for rectal cancer of colonic S-pouch ultralow anastomosis

Objective To evaluate the effect of S-pouch colorectal or coloanal anastomosis after low anterior resection for low rectal cancer of the older patients on improving the bowel function and clinical outcomes.Methods A prospective randomized trail was made. Between 2004 and 2007 consecutive 49 patients with low rectal cancer undergoing low anterior resection were divided into two groups based on the reconstruction of intestinal continuity: traditional straight coloanal anastomosis(straight group, n=24 ),or 5-cm colonic S-pouch rectal or anal anastomosis (S-pouch group, n= 25). Patients were followed-up and evaluated at 1,3,6,9,12 and 18 months post operation. Both groups were compared in surgical complications and bowel function.Results These two groups were not different in surgical complications. S-pounch group were better than straight group in bowel function in the Sixth month and one year post operation. Colonic S-pouch anastomosis resulted in better bowel movement and anorectal manometric findings than that of traditional straight coloanal anastomosis.Conclusions Colonic S-pouch anastomosis after low anterior resection can significantly improve the older patients' bowel function without increasing complication.