Katsumata K, Sumi T, Enomoto M, Mori Y, Aoki T
Department of Surgery, Tokyo Medical University, Tokyo, Japan. kenji.katsu @ jcom.home.ne.jp
Eur Surg Res. 2010;45(3-4):338-43. doi: 10.1159/000318604. Epub 2010 Nov 5.
Our questionnaire survey on defecation disorders after rectal cancer surgery revealed that 66.7% of postoperative patients were most annoyed with fragmentation of defecation. Therefore, we performed a change-over-time analysis on the relationship of fragmentation and factors including location of rectal cancer, surgical technique, anastomosis method, pouch reconstruction, extent of lymph node dissection, and degree of pelvic and colonic nerve preservation surrounding the superior mesenteric artery. The fragmentation decreased over time at the postoperative time points of 6 months, 2 and 5 years. A statistical analysis of factors influencing fragmentation revealed that location of cancer, reconstruction technique, anastomosis method and degree of pelvic nerve preservation were significant factors for the entire patient population and that colonic nerve preservation was a significant factor 5 years after surgery. Analysis of patients with lower rectal cancer only showed that in addition to surgical technique and anastomosis method, pouch reconstruction was effective and autonomic nerve preservation was effective 5 years after surgery. As a result, when the anastomotic site was closer to the anus, the frequency of fragmentation increased; we concluded that pouch reconstruction was an effective surgical technique and colonic nerve preservation was effective in the longer term.
我们对直肠癌手术后排便障碍的问卷调查显示，66.7%的术后患者最烦恼排便碎片化问题。因此，我们对排便碎片化与包括直肠癌位置、手术技术、吻合方法、储袋重建、淋巴结清扫范围以及肠系膜上动脉周围盆腔和结肠神经保留程度等因素之间的关系进行了随时间变化的分析。在术后6个月、2年和5年的时间点，排便碎片化情况随时间有所改善。对影响排便碎片化的因素进行统计分析发现，癌症位置、重建技术、吻合方法和盆腔神经保留程度对全体患者而言是显著因素，而结肠神经保留在术后5年是显著因素。仅对低位直肠癌患者的分析表明，除手术技术和吻合方法外，储袋重建有效，且自主神经保留在术后5年有效。结果发现，吻合部位越靠近肛门，排便碎片化的频率越高；我们得出结论，储袋重建是一种有效的手术技术，结肠神经保留从长远来看是有效的。
