结肠成形袋对改善直肠癌术后排便功能的作用

目的评价中下段直肠癌行结肠成形袋结肠-直肠(肛管)吻合术对改善术后排便功能的作用。方法将61例中下段直肠癌患者随机分成2组,第1组31例,制成结肠成形袋后与直肠(肛管)端端吻合(TCP组);第2组30例,行结肠断端与直肠(肛管)端端吻合(CAA组)。分别于术后3、6、12、15个月对患者排便功能进行评价。结果术后15个月时,TCP组患者每日平均排便2次、便后1h内需再排便者占4%、排便失禁综合评价0,均优于CAA组(分别为4次、12%和4);两组比较,差异有显著性意义(P<0.05)。术后6个月时TCP组直肠最大耐受压和顺应性压明显增加,分别为(162.3±2.0)ml/kPa和(28.3±1.7)ml/kPa,与CAA组(154.3±1.9)ml/kPa和(26.5±1.1)ml/kPa相比,差异有显著性意义(P<0.05)。术后两组出现吻合口瘘各1例。TCP组发生吻合口狭窄1例。结论结肠成形袋结肠-直肠(肛管)吻合术能明显改善直肠癌术后患者的排便功能。     

结肠贮袋直肠肛管吻合术对改善直肠癌术后排便功能的作用

目的评价中下段直肠癌低前切除结肠J型贮袋——直肠或肛管吻合对改善排便功能的作用。方法将1998年1月至2000年12月作低前切除的连续67例中下段直肠癌患者根据重建消化道的方法分为2组，第1组(34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（33例）断端结肠制成5～6cm的J型贮袋并与直肠肛管行端侧吻合（袋吻组）。分别于术后1、3、6、9个月和1年、1年半对排便功能进行评估，比较两组的手术并发症和排便功能指标。结果直吻组和袋吻组发生吻合口狭窄分别为3例和1例，直吻组术后出血1例，两组均无吻合口瘘和死亡病例。直吻组和袋吻组术后局部复发分别为4例和3例，直吻组术后肝转移1例。直吻组和袋吻组的日平均大便次数术后6个月分别为5和2次（P<0.001），术后1年分别为3和1次（P<0.05），术后1年半均为2次（P>0.05）。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。结论中下段直肠癌低前切除结肠J型贮袋直肠肛管吻合术不增加手术并发症，在术后第1年内有明显改善排便功能的作用。     

直肠癌前切除、结肠“J”型储袋对术后排便功能的影响

目的为探讨直肠癌行低位前切除术后应用结肠“J”型储袋行直肠或肛管吻合能否改善患者的排便功能。方法对2000年1月至2001年1月间连续行低位前切除术的72例中、下段直肠癌患者行回顾性分析。根据吻合方式分为两组：“J”型储袋组,共33例;直接吻合组,共37例。分别于术后1、3、6及12个月,对手术并发症及排便功能行比较性研究。结果发现两组均无手术死亡及术后出血病例。直吻组发生吻合口瘘2例;储袋组及直肠组术后吻合口狭窄分别为2例及1例;局部复发者各为3例;肝转移分别为2例及3例。“J”型储袋组较直接吻合组患者术后6个月及12个月之日排便次数及夜间排便人数比率均明显减少（7次vs3次,P〈0．05;3次VS1次,P〈0．05）,（64％VS31％,P〈0．05;30％VS3．9％,P〈0．05）。前者大便失禁综合评分显著优于后者（8VS2,P〈0．05;5．2VSL5,P〈0．05）。结论结果表明直肠癌行低位前切除术后,应用“J”型储袋行直肠或肛管吻合,不增加手术并发症,且在术后1年内,可以在某些方面改善患者排便功能。     

直肠癌低前切除结肠J型贮袋吻合与直接吻合的Meta分析

目的：评价直肠癌低前切除后采用结肠J型贮袋直肠肛管吻合与直接吻合相比对术后排便功能的影响。方法：从中下段直肠癌病例为研究对象,用rectal cancer,J pouch,randomized等作为关键词,检索出符合入选标准的随机对照临床试验,采用固定效应模型与随机效应模型对患者术后1年的排便功能及直肠生理指标进行Meta分析。结果：共筛选出符合入选标准的随机对照临床试验8项（378例）。术后1年结肠贮袋组在24h排便频次、有无急迫感和是否需要药物治疗方面均优于直接吻合组;2组在5项生理性评估指标中仅1项差异有显著性意义。结论：中下段直肠癌切除术后采用结肠J型贮袋直肠肛管吻合,术后1年内有明显改善排便功能的作用,但对直肠生理功能的影响尚等进一步研究。     

结肠成形术在低位直肠癌保肛手术中的应用研究

目的探讨结肠成形术在低位直肠癌保肛手术中的应用价值。方法将低位直肠癌患者随机分为两组,观察组34例（结肠成形术低位直肠或肛管吻合）和对照组42例（结肠与远端直肠或肛管直接吻合）,观察比较两组患者术后肛门控便功能恢复情况及并发症发生率。结果肛门功能观察组大便控制明显优于对照组,术后6个月观察组平均3次／d,对照组平均8．5次／d;术后12个月观察组平均1．5次／d,对照组平均5次／d,两组差异有统计学意义P〈0．01。结论结肠成形术后肛门功能恢复明显优于直接吻合组。     

介绍一种新型结肠贮粪袋手术——结肠成形术

为探讨减轻低位结直肠或结肠肛管吻合术后排便功能异常的新方法，对13例中低位直肠癌根治患者采用一种新的结肠贮粪袋手术用以替代原先的J型结肠贮粪袋，并观察其疗效。与同期结直肠或结肠肛管直接吻合组比较，术后患者近期排便功能有不同程度的改善；与J型结肠贮粪袋比较，该型贮粪袋具有方法简单实用、省时经济、术后并发症少、适应范围更广等优点。     

低位直肠癌根治结肠J形储袋肛管吻合759例术后排便功能的Meta分析

目的评估低位直肠癌根治切除结肠J形储袋肛管吻合(JP组)相对于直接结肠肛管吻合(SA组)的术后排便功能变化。方法在Pubmed,Cochrane library等数据库中检索2010年至1990年间发表的有关低位直肠癌根治结肠储袋肛管吻合手术的文献,由2位独立的研究人员进行文献筛选和数据提取,采用RevMan4.2软件进行Meta分析。结果 14项随机对照研究759例患者符合入选标准。共考查12项指标,其中每日排便次数JP组和SA组在半年以内[WMD=-3.43(-4.15,-2.36)]和1年[WMD=-1.28(-1.66,-0.91)]均存在显著差异(P0.01);急迫感、不能区分气便、需用止泻药和直肠顺应性存在部分差异;而需用垫片、肛门失禁、需用缓泻剂、需要灌肠和直肠静息压、最大收缩压和最大耐受容积在两个时间点均无差异(P0.05)。结论低位直肠癌根治结肠J形储袋肛管吻合在术后1年之内具有一定的排便功能优势。     

J型贮袋直肠吻合术对肛门功能影响的回顾性研究

目的评价低位直肠癌前切除保肛术后J型贮袋对改善排便功能的疗效。方法 60例患者行低位直肠癌前切除术以及结直肠或结肛吻合,其中22例应用J型贮袋（贮袋组）、38例应用结直肠或结肛直接吻合（无袋组）。记录并比较两组患者的术后并发症的发生情况及排便情况,对术后6个月和12个月的排便功能进行评估。结果两组间术后并发症发生率无明显差异。6个月后贮袋组患者在夜间溢便、漏稀便、区别排气排便和集团性排便方面明显优于无袋组。在术后6个月、12个月贮袋组的延缓排便均优于无袋组（P〈0.05）;两组在便不尽、需抗腹泻药和使用缓泻剂方面无显著性差异。结论结肠J型贮袋可改善低位直肠癌前切除患者术后早期的控变能力。     

结肠成形重建直肠壶腹在低位直肠癌保肛术中的应用

低位直肠癌保肛术后残余直肠过少，甚至缺如，超低位及结肠肛管吻合术往往导致肛门括约肌、肛垫及盆腔植物神经丛不同程度的损伤，因此保肛之后，常伴随控便能力的障碍。近年来国内外很多学者相继采用结肠贮袋直肠（肛管）吻合的方法以改善病人术后的排便功能问题。2002年1月～2004年1月我院采用结肠成形重建直肠壶腹治疗低位直肠癌，获得了满意疗效，现报道如下。     

结肠J型贮袋在低位直肠癌吻合术32例中的应用

目的探讨结肠J型贮袋在低位直肠癌手术中的应用。方法对我科2001年~2004年实施的直肠癌结肠J型贮袋肛管(直肠)吻合术32例的临床资料进行回顾性分析。结果全组无术中意外损伤及大出血病例。无死亡病例。发生吻合口狭窄1例。无吻合口漏及便秘。病人术后1年内排便状况满意。结论低位直肠癌行结肠J型贮袋肛管(直肠)吻合术具有操作方便、易于观察、容易推广等特点,有明显改善排便功能的作用,可显著提高病人术后的生活质量。     

Meta-analysis of colonic reservoirs versus straight coloanal anastomosis after anterior resection

BACKGROUND AND METHODS: The comparative benefits and drawbacks of straight coloanal anastomosis (CAA), colonic J-pouch and coloplasty anastomosis after anterior resection are uncertain. Studies published between 1986 and 2005 of colonic J-pouch versus transverse coloplasty or straight CAA were analysed. Endpoints included postoperative complications, and functional and physiological outcomes measured within 6 months, 1 year and 2 years or more after the procedure. A random-effect model was used to aggregate the study endpoints and assess heterogeneity. RESULTS: Thirty-five studies containing 2240 patients (1066 straight CAA, 1050 J-pouch and 124 coloplasty) were included. There was no significant difference in postoperative complications between the three groups. There was a significant reduction in the frequency of defaecation per day by 1.88, 1.35 and 0.74 motions at the three time intervals in the J-pouch group compared with the straight CAA group. Faecal urgency was less prevalent in patients with a J-pouch than those with a straight CAA (odds ratio 0.27 at 6 months or less and 0.21 at 1 year). There was no difference in functional outcome between J-pouch and coloplasty anastomosis. CONCLUSIONS: The colonic J-pouch provided functional benefits over straight anastomosis with no increase in postoperative complications. Coloplasty appeared to have similar benefits but further studies are required for validation.     

Function of a colonic J pouch continues to improve with time.

BACKGROUND: J pouch-anal anastomosis is thought to give superior functional results to straight coloanal anastomosis after rectal resection. Follow-up studies have suggested that this improvement is not maintained and that evacuatory difficulties may increase. METHODS: Some 119 consecutive patients had a coloanal anastomosis after resection for rectal carcinoma over 113 months, 62 with a J pouch and 57 with a straight coloanal anastomosis. Functional results were determined by patient questionnaire. The two groups were compared for the first and second 5-year intervals of study. RESULTS: Patients who had a J pouch had significantly better median Kirwan continence scores for the duration of the study and 5-9 years after surgery: 1 versus 2 (P = 0.05) and 1 versus 2 (P < 0.01), respectively. Some 5-9 years after surgery the median number of nocturnal bowel movements was significantly lower in patients who had a J pouch than in those with a straight coloanal anastomosis (0 versus 1; P = 0.02). Similarly, significantly better results were seen with regard to evacuation difficulties and urgency of defaecation. CONCLUSION: The function of the J pouch was superior to that of the straight coloanal anastomosis and appeared to improve with time.     

A New Surgical Concept for Rectal Replacement After Low Anterior Resection: The Transverse Coloplasty Pouch

OBJECTIVE: To analyze the feasibility, safety, complication and death rates, and early functional results of the transverse coloplasty pouch procedure after low anterior rectal resection and total mesorectal excision. SUMMARY BACKGROUND DATA: The authors previously developed a novel neorectal reservoir, the transverse coloplasty pouch, in an animal model; they report the first clinical data of a prospective phase 1 study. METHODS: Forty-one patients underwent low anterior rectal resection with total mesorectal excision for rectal cancer (n = 37) or benign pathology (n = 4). The continuity was restored with a transverse coloplasty pouch anastomosis, and the colon was defunctionalized for 3 months. Patients were followed up at 2-month intervals for functional outcome. RESULTS: Intraoperative complications occurred in three patients (7%), none related to the transverse coloplasty pouch. There were no hospital deaths and the total complication rate was 27% (11/41); an anastomotic leakage rate of 7% was recorded. The stool frequency was 3.4 per 24 hours at 2 months follow-up and gradually decreased to 2.1 per 24 hours at 8 months. Stool dysfunctions such as stool urgency, fragmentation, and incontinence grade 1 and 2 were regularly observed until 6 months; the incidence significantly decreased thereafter. None of the patients had difficulties in pouch evacuation. CONCLUSIONS: The transverse coloplasty pouch is a small-volume reservoir that can safely be used for reconstruction after sphincter-preserving rectal resection. The early functional outcome is favorable and can be compared to other colonic reservoirs. The concept of reducing early dysfunction seen after straight coloanal anastomosis and avoiding long-term problems of pouch evacuation is supported by this study. Future trials will compare the transverse coloplasty pouch with other techniques of restorative resections of the rectum.     

Coloanale Anastomose: Verbesserung der funktionellen Frühergebnisse durch Rekonstruktion mit Colonpouch

INTRODUCTION: Early functional outcome after ultra-low anterior resection with coloanal anastomosis (CAA) may be improved by construction of a colonic pouch. The aim of this prospective observational study was to compare results of colonic pouch-anal anastomosis (CPAA) with conventional CAA including the learning curve. METHODS: From February 1996 through May 1998, 45 consecutive patients underwent CAA or CPAA following radical rectal resection for cancer. The technique of resection was identical in both groups, and all patients received a diverting stoma. The colonic pouch was constructed using linear staplers. Three and 12 months following stoma closure subjective continence and bowel habits were assessed; anal manometry was performed at 3 months. RESULTS: 20 patients with CPAA (9 F, 11 M, age 62 +/- 9 years) were compared to 25 CAA patients (11 f, 14 m, age 64 +/- 10 years). There was no mortality, and morbidity was comparable between groups. Three months following stoma closure, in the CPAA group bowel frequency was significantly diminished (1.4 vs 5.8; P < 0.0001), fewer patients had liquid motions (0/20 vs 12/25 patients; P < 0.0001), and more were continent (20/20 vs 4/25; P < 0.001) and able to defer defaecation (20/20 vs 2/25; P < 0.0001). Functional anal canal length was significantly shorter in CPAA patients (2.9 vs 3.5 cm; P < 0.008). Although at 12 months follow-up continence had improved in patients with CAA, bowel frequency (2.5 vs 1.3; P < 0.002), and number of patients with liquid motions (10/25 vs 0/20; P < 0.007) and passive incontinence (12/25 vs 0/20; P < 0.0001) were still significantly higher than the CPAA group. CONCLUSION: Even including the learning curve, CPAA may yield superior functional results at 3 months and 1 year compared to conventional CAA without increasing morbidity.     

结肠成形袋与结肠J型袋改善直肠癌术后排便功能的比较

目的比较结肠成形袋和结肠J型袋对改善直肠癌术后排便功能的作用。方法将73例中下段直肠癌随机分成两组，第1组（CPP组）36例，行结肠成形袋手术。第2组（CJP组）37例，行结肠J型袋手术。分别于术后6、12个月对患者排便功能进行评价。结果CPP组均成功实施了结肠成形袋手术，但CJP组有4例（10％）因盆腔狭窄、肥胖未能成功实施结肠J形袋手术。术后6个月时两组每日平均排便次数为4．3和4．5，便后1h内需再次排便为23％和20％，大便失禁评分为3和4。两组差异无统计学意义（t=0．384，x^2=0，101，t=0．643，P〉0．05）。术后12个月对每日平均便次、便后1h内需再次排便、大便失禁等情况进行综合评分。CPP组和CJP组分别为：2．4次、2．2次；5％、6％及2、3分。两组差异无统计学意义（t=0．419，x^2=0．506，t=0．582，P〉0．05）。结论结肠成形袋和结肠J型袋对改善直肠癌术后排便功能的作用相似。结肠成形袋方法简单、临床效果肯定，是一种很有前途的结肠贮袋手术.     

Experimental study of neorectal physiology after formation of a transverse coloplasty pouch

BACKGROUND: A novel transverse coloplasty pouch (TCP) with a larger neorectal volume than a straight coloanal anastomosis (CAA) but a smaller volume than a short colonic J pouch (CJP) may improve short-term function after rectal excision. METHODS: Twelve pigs were investigated 6 weeks after complete rectal excision followed by reconstruction with a CAA, CJP or TCP. The results were compared with findings in the normal pig rectum. RESULTS: The colonic transit times assessed by radio-opaque marker transit were 24 h for CAA, 60 h for CJP and 32 h for TCP. Non-operated control pigs had a mean transit time of 46 h. Pigs that had a CJP developed colonic dilatation and substantial faecal impaction. Colonic electrostimulation induced an adaptive relaxation in the normal rectum but a pressure increase in all neorecta, particularly after CAA. The neorectal longitudinal smooth muscle layer in pigs with a TCP was significantly thicker than that in pigs with a CAA or CJP; its thickness was closest to that of the normal pig rectum. Colonic smooth muscle layers 10 cm proximal to the coloanal anastomosis, above the neorecta, were significantly thicker after CJP than after CAA or TCP formation. No significant difference in microcirculation was observed between the three restorative procedures. CONCLUSION: Accelerated colonic transit and a lack of adequate relaxation upon endoluminal pressure increase was associated with urgency and incontinence after CAA. Delayed colonic transit, faecal impaction and ineffective muscular hypertrophy due to pouch dilatation and constipation indicated evacuation problems after CJP construction. Functional and morphometric data for TCPs suggested almost normal defaecation. Of the three restorative procedures, the data for TCPs were most similar to those obtained in the normal pig rectum at short-term follow-up.     

Transverse coloplasty pouch and colonic J-pouch for rectal cancer – a comparative study

Objectives The introduction of the colonic J‐pouch has markedly improved the functional outcome of restorative rectal cancer surgery. However colonic J‐pouch surgery can be problematic and may present some late evacuatory problems. To overcome these limitations a novel pouch has been proposed: the transverse coloplasty pouch. The purpose of our study was to compare the functional outcomes of these two different types of pouches – the transverse coloplasty pouch (TCP) and the colonic J‐pouch (CJP) – during the first 12 months postoperatively. Patients and methods A prospective randomized trial was conducted in which a total of 30 patients with mid and low rectal cancer were submitted either to a transverse coloplasty pouch or a colonic J‐pouch. Clinical defaecatory function was assessed and anorectal physiological assessment was carried out, pre‐operatively and at 3, 6 and 12 months postoperatively, by means of a standard clinical questionnaire and by anorectal manometry. Results No statistically significant differences were found between the two groups regarding bowel function. The postoperative frequency of daily bowel movements was lower in the TCP group in all the phases of the study (3.9 vs. 4.1 at 3 months; 3.1 vs. 3.4 at 6 months; 2.1 vs. 2.8 at 12 months), the same occurring with fragmentation (33%vs. 40% at 3 months; 26.6%vs. 33.3% at 6 months; 7.1%vs. 14.3% at 12 months). Less urgency was also seen in the TCP group during the first 6 months (20%vs. 26.7%), with identical values at 12 months (14.3%vs. 14.3%). No significant differences were also found concerning incontinence grading and scoring, with TCP patients having less nocturnal leaks. At one year two CJP patients (14.3%) needs the use of enemas to evacuate the pouch and provoke defaecation, a problem never seen in TCP patients. The anorectal manometry data was similar in both types of pouches. The local complication rates were also identical in the two groups (20%); more anastomotic leaks were seen in TCP patients (13.2%vs. 6.6%), without reaching a statistical significance. Conclusion The transverse coloplasty pouch has similar functional results but fewer evacuation problems than the J‐Pouch, making it a safe and reliable alternative to the colonic J‐pouch.     

Colonic pouch confers better bowel function and similar postoperative outcomes compared to straight anastomosis for low rectal cancer

BACKGROUNDWith advancements in laparoscopic technology and the wide application of linear staplers, sphincter-saving procedures are increasingly performed for low rectal cancer. However, sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome. Colonic pouch anastomosis improves the quality of life of patients with rectal cancer > 7 cm from the anal margin. But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.AIMTo compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.METHODSWe conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses. Functional evaluations were completed preoperatively and at 1, 6, and 12 mo postoperatively. We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.RESULTSThere were no significant differences in mean operating time, blood loss, time to first passage of flatus and excrement, and duration of hospital stay between the colonic pouch and straight anastomosis groups. The incidence of anastomotic leakage following colonic pouch construction was lower (11.4% vs 16.2%) but not significantly different than that of straight anastomosis. Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group, suggesting better bowel function (preoperative: 4.71 vs 3.89, P = 0.43; 1 mo after surgery: 34.2 vs 34.7, P = 0.59; 6 mo after surgery: 22.70 vs 29.0, P < 0.05; 12 mo after surgery: 15.5 vs 19.5, P = 0.01). The overall recurrence and metastasis rates were similar (4.3% and 11.4%, respectively).CONCLUSIONColonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections. Moreover, colonic pouch construction may provide better functional outcomes compared to straight anastomosis.