直肠癌低位前切除术后结肠J袋与直接吻合的长期功能变化比较。

Long-term functional changes after low anterior resection for rectal cancer compared between a colonic J-pouch and a straight anastomosis.

作者信息

Hida Jin-ichi, Yoshifuji Takehito, Matsuzaki Tomohiko, Hattori Takashi, Ueda Kazuki, Ishimaru Eizaburou, Tokoro Tadao, Yasutomi Masayuki, Shiozaki Hitoshi, Okuno Kiyotaka

机构信息

Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama Osaka 589-8511, Japan.

出版信息

Hepatogastroenterology. 2007 Mar;54(74):407-13.

PMID:17523285

Abstract

BACKGROUND/AIMS: We prospectively compared changes in function between colonic J-pouch and straight anastomoses from 1 to 5 years after low anterior resection for rectal cancer.

METHODOLOGY

At 1, 3, and 5 years after surgery, functional outcome was compared between 48 patients with J-pouch reconstruction (J group) and 51 with straight anastomosis (S group), using a 17-item questionnaire (overall best, 0; overall worst, 26). Reservoir function was evaluated manovolumetrically.

RESULTS

At 5 years, patients with ultralow anastomoses (< or =4 cm from anal verge) had fewer bowel movements during day or night, and less urgency and soiling in the J than S group. At that time, patients with low anastomoses (5 to 8 cm above the verge), had fewer bowel movements at night and less urgency in the J than S group. Manovolumetric results were better in the J than S group for both anastomotic levels. Functional scores improved significantly over time for both anastomotic levels, especially in the S group. Mean scores with ultralow anastomoses were J-group, 5.6 at 1 year vs. 5.3 at 3 years (P = 0.0304) vs. 3.7 at 5 years (P < 0.0001); and S group, 10.2 at 1 year vs. 9.6 at 3 years (P = 0.0063) vs. 7.3 at 5 years (P < 0.0001). Mean scores with low anastomoses were J group, 3.4 at 1 year vs. 3.1 at 3 years (P = 0.0052) vs. 2.1 at 5 years (P = 0.0003); and S group, 5.2 at 1 year vs. 3.8 at 3 years (P < 0.0001) vs. 2.7 at 5 years (P < 0.0001). Manovolumetric results improved overtime in both groups.

CONCLUSIONS

Functional outcome improved in the J and especially the S group over 5 years. However, function was better in the J than S group at all time points.

摘要

背景/目的：我们前瞻性地比较了直肠癌低位前切除术后1至5年结肠J形贮袋吻合术与直接吻合术之间的功能变化。

方法

在术后1年、3年和5年，使用一份包含17个条目的问卷（总分最佳为0分；总分最差为26分），对48例行J形贮袋重建术的患者（J组）和51例行直接吻合术的患者（S组）的功能结局进行比较。通过容量压力测定法评估贮袋功能。

结果

在5年时，超低位吻合术（距肛缘≤4 cm）的患者，J组白天或夜间排便次数较S组少，便急和便污情况也较轻。此时，低位吻合术（距肛缘5至8 cm）的患者，J组夜间排便次数较S组少，便急情况也较轻。在两种吻合水平上，J组的容量压力测定结果均优于S组。随着时间推移，两种吻合水平的功能评分均显著改善，尤其是S组。超低位吻合术的平均评分：J组，1年时为5.6分，3年时为5.3分（P = 0.0304），5年时为3.7分（P < 0.0001）；S组，1年时为10.2分，3年时为9.6分（P = 0.0063），5年时为7.3分（P < 0.0001）。低位吻合术的平均评分：J组，1年时为3.4分，3年时为3.1分（P = 0.0052），5年时为2.1分（P = 0.0003）；S组，1年时为5.2分，3年时为3.8分（P < 0.0001），5年时为2.7分（P < 0.0001）。两组的容量压力测定结果均随时间得到改善。