Ho Yik-Hong
World J Gastroenterol. 2006 Oct 21;12(39):6252-60. doi: 10.3748/wjg.v12.i39.6252.
A very low local recurrence rate of 3%-6% (associated with improved 5 year survival) is possible when proper oncological surgery is performed of mid and distal rectal adenocarcinoma. Restoration of bowel continuity is possible in most cases, without compromise of cancer clearance. Re-anastomosis can be performed with stapled, transabdominal hand-sewn or coloanal pull-through techniques. However after a direct (straight) anastomosis of the colon to the distal rectum/anus, up to 33% of patients have 3 or more bowel movements/d; some can be troubled with up to 14 stools a day. Construction of a 6-cm colonic J-pouch is likely to cause some reversed peristalsis which improves postoperative bowel frequency without causing neo-rectum evacuation problems. Colonic J-pouch-anal anastomosis patients have a median of 3 bowel movements a day compared with a median of 6 a day for straight anastomoses, at 1 year after surgery. In the longer term, bowel adaptation may enable the function after a straight anastomosis to approximate that of a colonic J-pouch-anal anastomosis. This probably depends in the former, upon whether the more rigid sigmoid colon or more distensible descending colon is used. An additional advantage of the colonic J-pouch-anal anastomosis is the lower risk of anastomotic complications. A more vascularized side-to-end (colonic J-pouch-anal) anastomosis is likely to heal better than an end-to-end (straight) anastomosis. Where the pelvis is too narrow for a bulky colonic J-pouch anal anastomosis, a coloplasty-anal-anastomosis is an option. The latter results in postoperative bowel function comparable with the colonic J-pouch. However, the risk of anastomotic complications is higher possibly related to its end-to-end anastomotic configuration. Laparoscopic techniques for accomplishing all the above are being proven to be effective. Restorative surgery for rectal cancer can be safely and effectively performed with methods to improve bowel function very acceptably; the future advances are likely in laparoscopy.
对中低位直肠腺癌进行适当的肿瘤外科手术后，局部复发率可低至3%-6%（5年生存率也会提高）。在大多数情况下，肠道连续性可以恢复，且不影响癌症清除效果。可以采用吻合器吻合、经腹手工缝合或结肠肛管拖出术进行再吻合。然而，在结肠与直肠远端/肛门直接（端端）吻合后，高达33%的患者每天排便3次或更多；有些人每天排便多达14次。构建一个6厘米的结肠J形贮袋可能会引起一些逆蠕动，这会改善术后排便频率，且不会导致新直肠排空问题。结肠J形贮袋肛管吻合术患者术后1年每天排便中位数为3次，而端端吻合术患者为6次。从长远来看，肠道适应性可能使端端吻合术后的功能接近结肠J形贮袋肛管吻合术。这可能取决于前者使用的是较僵硬的乙状结肠还是更具扩张性的降结肠。结肠J形贮袋肛管吻合术的另一个优点是吻合口并发症风险较低。血管化程度更高的端侧（结肠J形贮袋肛管）吻合可能比端端（直接）吻合愈合得更好。如果骨盆过窄，无法进行大型结肠J形贮袋肛管吻合术，结肠成形术肛管吻合术是一种选择。后者术后肠道功能与结肠J形贮袋相当。然而，吻合口并发症的风险可能更高，这可能与其端端吻合的结构有关。事实证明，采用腹腔镜技术完成上述所有操作是有效的。直肠癌的修复性手术可以安全有效地进行，且改善肠道功能的方法非常令人满意；未来的进展可能在于腹腔镜手术。
