Lin Jen-Kou, Wang Huang-Sheng, Yang Shung-Haur, Jiang Jeng-Kae, Chen Wei-Shone, Lin Tzu-Chen
Department of Surgery, National Yang-Ming University, Taipei Veterans General Hospital, Taiwan.
Surg Today. 2002;32(6):487-92. doi: 10.1007/s005950200082.
This study was designed to compare the long-term results of straight and J-pouch coloanal anastomoses after resection of rectal cancers located in the critical position of 5-6cm from the anal verge.
The subjects of this study were 81 patients who underwent radical resection of rectal cancers located 5-6 cm from the anal verge, followed by straight or J-pouch coloanal anastomosis, performed in 41 and 40 patients, respectively. Careful clinical and manometric follow-up was conducted and the results were compared.
There were no differences in the incidence of local recurrence, the disease-free survival rate, postoperative stool frequency, continence, sphincter pressures, or functional length between the two groups. Both groups had a high incidence of clustering or fragmented defecation; however, the J-pouch patients had better urgency control, a greater capacity before feeling the urge to defecation, superior rectal tolerance, and better compliance.
Both straight and J-pouch coloanal anastomoses are oncologically and functionally acceptable for the treatment of rectal cancer located 5-6cm from the anal verge, but the J pouch has slight superiority in urgency control, as a result of larger urge threshold and tolerable volume, and better compliance. The reason for the high incidence of clustering defecation in both groups needs to be investigated.
本研究旨在比较距肛缘5 - 6cm关键位置直肠癌切除术后直结肠肛管吻合术和J形贮袋结肠肛管吻合术的长期结果。
本研究的对象为81例行距肛缘5 - 6cm直肠癌根治性切除术的患者，分别对41例和40例患者进行了直结肠肛管吻合术和J形贮袋结肠肛管吻合术。进行了仔细的临床和测压随访并比较结果。
两组在局部复发率、无病生存率、术后排便频率、控便能力、括约肌压力或功能长度方面均无差异。两组均有较高的成簇或碎片化排便发生率；然而，J形贮袋患者在急迫感控制方面更好，排便冲动前容量更大，直肠耐受性更好，顺应性更佳。
直结肠肛管吻合术和J形贮袋结肠肛管吻合术在治疗距肛缘5 - 6cm的直肠癌方面在肿瘤学和功能上均可接受，但由于冲动阈值更高、可耐受容量更大以及顺应性更好，J形贮袋在急迫感控制方面略有优势。两组成簇排便发生率高的原因有待研究。
