不同肠道重建方式对低位直肠癌保肛术后肛门功能的影响

目的研究直接吻合术、结肠成形袋术和J型贮袋术对低位直肠癌保肛术后肛门功能的影响。方法选择2007年1月。2011年5月在郑州大学附属郑州中心医院治疗的低位直肠癌患者109例，随机分为直吻组36例行直接吻合术，结袋组37例行结肠成形袋术，J袋组36例行J型贮袋术，观察三组患者术后肛门功能情况。结果三组均无死亡；直吻组、结袋组、J袋组手术重建成功率94．44％（34／36）、97．30％（36／37）、94．44％（34／36）1、术后并发症发生率8．82％（3／34）、5．55％（2／36）、5．88％（2／34）1差异均无统计学意义（均P〉0．05）。术后3、6、12个月结袋组和J袋组24h排便次数、不能区分排便和排气均显著少于直吻组，差异有统计学意义（P〈0．05或JP〈0．01）；术后3、6、12个月三组大便不能完全排空感差异无统计学意义（P〉0．05）；术后3个月三组肛门功能主观感受评价得分差异无统计学意义（P〉0．05）；术后6、12个月结袋组（7．83±1．75）、（8．34±1．85）分]和J袋组（7．69±1．63）、（8．41±1．74）分]肛门主观感受评价得分显著高于直吻组（6．36±1．78）、（6．89±1．67）分]，差异有统计学意义（P〈0．05或P〈0．01）。术后3、6、12个月结袋组和J袋组静息压和最大耐受容量高于直吻组，术后12个月结袋组和J袋组最大收缩压和顺应性均高于直吻组，差异均有统计学意义（P〈0．05）；结袋组和J袋组静息压、最大收缩压、最大耐受容量、顺应性等指标差异无统计学意义（P〉0．05）。结论直接吻合术对低位直肠癌全直肠结肠系膜切除术后患者肛门功能影响最为显著．结肠成形袋和J型贮袋术改善患者术后肛门功能作用相似，结肠成形袋方法更简单。

Effect of different intestinal reconstruction of anal function in low rectal cancer ZHANG Guoyun PAN Zhongping

Objective To study the effect of direct anastomosis surgery, colon forming marsupialization and J-pouch surgery of anal function in low rectal cancer. Methods 109 patients with low rectal cancer from January 2007 to May 2011 in Affiliated Zhengzhou Central Hospital of Zhengzhou University were selected and randomly divided into 3 groups. 36 cases in anastomosis group were treated with direct anastomosis, 37 cases in colon forming group were treated with colon shaping marsupialization, 36 cases in J pouch group were treated with J pouch surgery; the anal function in 3 groups were observed. Results No death was found in 3 groups; the differences of success rate of surgical reconstruction 94.44% （34/36）, 97.30% （36/37）, 94.44% （34/36）], postoperative complications rate 8.82% （3/34）, 5.55%（2/36）, 5.88%（2/34）] in anastomosis group, colon forming group, J pouch group were not statistically significant （P 〉 0.05）. 24 h stool frequency, incapacity of bowel movements and exhaust in colon forming group and J pouch group 3, 6, 12 months after the operation were lower than those in anastomosis group, the differences were statistically significant （P 〈 0.05 or P 〈 0.01）; the differences of incapacity of stool exhausting in 3 groups 3, 6, 12 months after the operation were not statistically significant （P 〉 0.05）; the differences of scores of subjective feeling anal function in 3 groups 3 months after the operation were not statistically significant （P 〉 0.05）; scores of subjective feeding anal function 3, 6 months after the operation in colon forming group （7.83±1.75）, （8.34±1.85） scores] and J pouch group （7.69±1.63）, （8.41±1.74）scores] were higher than those in anastomosis group （6.36±1.78）, （6.89±1.67） scores], the differences were statistically significant （P 〈 0.05 or P 〈 0.01）. Anal resting pressure and maximum capacity in colon forming group and J pouch group 3, 6, 12 months after the operation were all higher than those in anastomosis group, maxinmm systolic pressure and elasticity in colon forming group and J pouch group 12 months after the operation were all higher than those in anastomosis group, the differences were statistically significant （P 〈 0.05）; the differences of anal resting pressure, maximum capacity, maximum systolic pressure and elasticity in 3 groups were not statistically significant （P 〉 0.05）. Conclusion Direct anastomosis has the most remarkable influence of anal function in low rectal cancer after mesocolon resection surgery, the colon forming bags and J pouch surgery could improve postoperative anal tunction, the colon forming bag method is more simple.