Damianov N, Tankova L, Draganov V
Khirurgiia (Sofiia). 2003;59(1-2):32-4.
According to up-to-date concepts for local spread of a rectal cancer it is possible to perform a radical rectal resection with a restorative anastomosis inspite of the fact that the tumor is located in the middle or the distal third of the rectum. Usually a total resection of the rectum and coloanal anstomosis have to be performed. There are two ways to restore the continuity of the gut: a straight coloanal anstomosis or J pouch anastomosis. 22 patients with rectal cancer localized between 4 and 9 cm from the anal verge, were operated and restorative anastomoses were performed. The first 18 patients were with a straight coloanal anastomosis. In the last 4 cases coloanal anastomoses were done between the anus and colocolic 7 cm J pouch. During the first month there were 6 patients with total and 9 with partial incontinence in the group with straight coloanal anastomosis. Transrectal sonography confirmed contractility of the puborectal muscle and sphinctermanometry showed lower resting tone and squeeze pressure in cases with incotinence. No incontinence was observed in the group with J pouch and the shinctermanometry data were the same as these of healthy controls.
The rectal ampula has reservoir function and its loss after total resection of the rectum is the reason for frequent bowel movements, urgency and leakage. Reconstruction with a colonic J pouch is associated with better bowel function compared to the straight coloanal anastomosis.
根据直肠癌局部扩散的最新概念，尽管肿瘤位于直肠中下段，仍有可能进行根治性直肠切除术并进行恢复性吻合。通常需要进行直肠全切除和结肠肛管吻合术。恢复肠道连续性有两种方法：直接结肠肛管吻合术或J形贮袋吻合术。对22例距肛缘4至9厘米的直肠癌患者进行了手术并进行了恢复性吻合术。前18例患者采用直接结肠肛管吻合术。在最后4例中，在肛门与7厘米结肠结肠J形贮袋之间进行了结肠肛管吻合术。在第一个月，直接结肠肛管吻合术组中有6例完全失禁，9例部分失禁。经直肠超声检查证实耻骨直肠肌有收缩功能，测压显示失禁患者静息张力和挤压压力较低。J形贮袋组未观察到失禁，测压数据与健康对照组相同。
直肠壶腹具有贮便功能，直肠全切除后其丧失是导致频繁排便、急迫感和渗漏的原因。与直接结肠肛管吻合术相比，结肠J形贮袋重建与更好的肠道功能相关。
