结肠成型袋对改善中低位直肠癌术后排便功能的作用

目的：探讨结肠成型袋对改善中低位直肠癌术后排便功能的作用。方法：将62例中下段直肠癌患者根据消化道重建方法分为两组,32例行传统的结肠断端与直肠肛管直接端端吻合（CAA组）,30例断端结肠先行结肠成型术制成结肠贮袋再与直肠肛管行端端吻合（TCP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：CAA组和TCP组平均大便次数：术后6个月分别为5次和2次（P〈0.001）,术后1年分别为3次和1次（P〈0.05）,术后1年半均为2次（P〉0.05）。TCP组定性排便控制能力近期优于CAA组。结论：中下段直肠癌低位前切除结肠成型术后直肠肛管吻合不增加手术并发症,在术后第1年内有明显改善排便功能的作用。

Effect of Transverse Coloplasty Pouch and Coloanal Anastomosis on Improving Defecation after Resection for Rectal Carcinoma

Objective To evaluate the effects of transverse coloplasty pouch and coloanal anastomosis on improving defecation after resection for rectal carcinoma Methods A prospective randomized trail was made in 62 consecutive patients undergoing low anterior resection who were divided into two groups based on the reconstruction of intestinal continuity：traditional straight coloanal anastomosis （CAA group,n=32） or coloplasty pouch （TCP group,n =30）.Patients were followed-up and evaluated for 1,3,6,9,12 and 18 months postoperatively.Their surgical complications and bowel function were compared.The two groups were well matched for gender,age,histological stage. Results Patients with coloplasty pouch displayed significantly better function in terms of frequency of defecation per 24 hours postoperatively （6 months,5 vs 2;P〈0.001;12 months,3 vs 1;P〈0.05;18 months,2 vs 2;P〉0.05）.Coloplasty pouch anastomosis in TCP group resulted in better bowel movement than the traditional straight coloanal anstomosis in CAA group. Conclusions Coloplasty pouch anastomodis after low anterior resection can significantly improve the bowel function without increasing the morbidity.