Morihiro Masato, Koda Keiji, Seike Kazuhiro, Miyauchi Hideaki, Miyazaki Masaru
Department of General Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
Int J Colorectal Dis. 2008 Sep;23(9):883-92. doi: 10.1007/s00384-008-0485-1. Epub 2008 May 29.
This study used postoperative defecography to characterize morphological features of defecatory disorders in patients following rectal resection. We also evaluated differences in dynamic defecatory condition depending on reconstruction methods for sphincter-saving surgery.
Subjects comprised 62 patients (male/female, 41/21; mean age, 61 years) who underwent defecography after sphincter-saving surgery for rectal cancer. Semisolid barium (100 ml) was introduced into the rectum, and images were taken in a sitting position. Characteristic dynamic findings in defecography were evaluated according to operative methods and were compared with symptoms of defecatory disorders.
Defecographic findings closely associated with postoperative defecatory disorder were as follows: (1) low volume of neorectum in patients with worse incontinence grade (p < 0.05), (2) low evacuation fraction in patients with significantly impaired function such as soiling, urgency, and worsened incontinence score (p < 0.05), (3) minor alteration of anorectal angle at evacuation in patients with major soiling and worsened incontinence score (p < 0.05), and (4) barium shadow in the anal canal at rest in patients with urgency (p < 0.05). By reconstruction method, the J-pouch displayed a larger volume than straight anastomosis but a significantly wider anorectal angle than high anterior resection (HAR). Side-to-end anastomosis offered a moderate volume and a sharp anorectal angle as in HAR.
Defecography is useful for visualizing and characterizing defecatory disorders following rectal resection. Based on defecography, J-pouch reconstruction offers advantageous volume, while side-to-end anastomosis provides a more acute anorectal angle for patients who have received rectal resection with low anastomosis. A new reconstruction method offering both advantages was discussed.
本研究采用术后排粪造影来描述直肠切除术后患者排便障碍的形态学特征。我们还评估了保肛手术重建方法对动态排便情况的影响。
研究对象为62例直肠癌保肛手术后接受排粪造影的患者（男41例，女21例；平均年龄61岁）。将100ml半固体钡剂注入直肠，患者取坐位进行图像采集。根据手术方法评估排粪造影的特征性动态表现，并与排便障碍症状进行比较。
与术后排便障碍密切相关的排粪造影表现如下：（1）失禁程度较重的患者新直肠容积较小（p<0.05）；（2）有便污、急迫感和失禁评分恶化等功能明显受损的患者排空分数较低（p<0.05）；（3）有严重便污和失禁评分恶化的患者排便时肛管直肠角变化较小（p<0.05）；（4）有急迫感的患者静息时肛管内有钡剂残留（p<0.05）。就重建方法而言，J形贮袋的容积比端端吻合大，但肛管直肠角比高位前切除术（HAR）宽得多。侧端吻合的容积适中，肛管直肠角与HAR一样尖锐。
排粪造影有助于直观显示和描述直肠切除术后的排便障碍。基于排粪造影结果，J形贮袋重建可提供有利的容积，而侧端吻合可为低位吻合直肠切除术后的患者提供更锐利的肛管直肠角。文中讨论了一种兼具两者优点的新重建方法。
