Dehni Nidal, McNamara Deborah A, Schlegel Rodulfo D, Guiguet Marguerite, Tiret Emmanuel, Parc Rolland
Centre de Chirurgie Digestive, University Hospital Saint Antoine, Paris, France.
Dis Colon Rectum. 2002 Dec;45(12):1635-40. doi: 10.1007/s10350-004-7251-4.
Preoperative radiotherapy is increasingly used for certain rectal cancers, although some evidence suggests that it may adversely affect anorectal function. Reconstruction with a colonic J-pouch-anal anastomosis after complete proctectomy is thought to improve function, but few published data on pouch function after radiation exists. The aim of our study was to compare long-term bowel habits in patients receiving preoperative radiation for rectal cancer followed by colonic J-pouch-anal anastomosis with those of patients having similar rectal cancer surgery without radiation.
Patients (n = 125) having undergone colonic J-pouch-anal anastomosis for rectal cancer, of whom 28 had preoperative radiotherapy and 97 did not, responded to a detailed questionnaire about their bowel habits at least 12 months after surgery, with a mean (+/- standard deviation) interval of 64 (+/-42) months. Radiation was administered preoperatively as a short (25 Gy over 5 days, n = 22) or long (45 Gy over 4 weeks, n = 6) course. All patients had colonic J-pouch-anal anastomosis with manual anastomosis at or immediately above the dentate line.
Except for tumor stage, no preoperative difference was observed between the two groups. The number of bowel movements per 24 hours in patients with and without radiation was 1.8 (+/-0.8) and 1.8 (+/-1.5), respectively (P> 0.05). In the irradiated group, diarrhea (39 vs.13 percent, P= 0.005) and nocturnal defecation (36 vs.15 percent, P= 0.03) were more frequent than in the nonirradiated group. No other significant difference existed between groups with regard to stool clustering, use of protective pads, ability to defer evacuation >15 minutes, ability to evacuate the bowel within 30 minutes, incontinence score, use of medications, or dietary restriction.
Preoperative radiotherapy followed by proctectomy and colonic J-pouch-anal anastomosis significantly increased nocturnal defecation frequency and diarrhea compared with similar nonirradiated patients but had no influence on the other bowel-habit parameters studied.
术前放疗越来越多地用于某些直肠癌患者，尽管一些证据表明它可能对肛门直肠功能产生不利影响。全直肠切除术后采用结肠J形贮袋肛管吻合术进行重建被认为可改善功能，但关于放疗后贮袋功能的已发表数据很少。我们研究的目的是比较接受直肠癌术前放疗后行结肠J形贮袋肛管吻合术的患者与接受类似直肠癌手术但未放疗的患者的长期排便习惯。
125例因直肠癌接受结肠J形贮袋肛管吻合术的患者，其中28例接受了术前放疗，97例未接受放疗，在术后至少12个月对一份关于他们排便习惯的详细问卷进行了回复，平均（±标准差）间隔时间为64（±42）个月。术前放疗采用短疗程（5天内25 Gy，n = 22）或长疗程（4周内45 Gy，n = 6）。所有患者均行结肠J形贮袋肛管吻合术，在齿状线或其上方立即进行手工吻合。
除肿瘤分期外，两组术前未观察到差异。接受放疗和未接受放疗的患者每24小时排便次数分别为1.8（±0.8）次和1.8（±1.5）次（P>0.05）。在放疗组中，腹泻（39%对13%，P = 0.005）和夜间排便（36%对15%，P = 0.03）比未放疗组更频繁。在粪便聚集、使用护垫、推迟排便>15分钟的能力、30分钟内排便的能力、失禁评分、药物使用或饮食限制方面，两组之间没有其他显著差异。
与未接受类似放疗的患者相比，术前放疗后行直肠切除和结肠J形贮袋肛管吻合术显著增加了夜间排便频率和腹泻，但对所研究的其他排便习惯参数没有影响。
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