Azizi Rasoul, Alvandipour Mina, Shoar Saeed, Mahjoubi Bahar
1Rasoul-e-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Surg Innov. 2013 Oct;20(5):471-7. doi: 10.1177/1553350612469280. Epub 2012 Dec 10.
Abdominal perineal resection (APR) with applied colostomy remains the standard treatment for low rectal cancer; however, to date, a very high morbidity rate has been reported.
The aims of this study were to assess fecal continence, persistence of disease-related symptoms, and quality of life in patients with low rectal cancer after APR and pseudocontinent perineal colostomy and concomitant appendicostomy.
We included 17 patients with low rectal cancer who underwent APR at our hospital in this cross-sectional study. Following APR, pseudocontinent perineal colostomy and concomitant appendicostomy were performed. Patients then underwent antegrade colonic enema with tap water. Patients' symptoms, fecal continence, and quality of life were evaluated at regular time intervals.
After a median follow-up of 12 months, 15 of 17 patients completed the study period. All patients were able to perform an antegrade enema by themselves. Mean continence score was 7 (out of 20) based on the Wexner Scale scoring system. Mean global health status score was 78, physical function was 93, and emotional function was 88. Minor morbidity was observed in 6 patients (40%).
Pseudocontinent perineal colostomy with appendicostomy provides an acceptable level of continence and functional and emotional improvement in patients with low rectal cancer undergoing APR. Hence, this combinative method could be considered as an alternative for abdominal colostomy in selected patients.
腹会阴联合切除术（APR）加结肠造口术仍是低位直肠癌的标准治疗方法；然而，迄今为止，已报道其发病率非常高。
本研究的目的是评估低位直肠癌患者在接受 APR、假可控性会阴结肠造口术及同期阑尾造口术后的大便失禁情况、疾病相关症状的持续存在情况以及生活质量。
在这项横断面研究中，我们纳入了 17 例在我院接受 APR 的低位直肠癌患者。APR 术后，进行了假可控性会阴结肠造口术及同期阑尾造口术。然后患者接受用自来水进行的顺行结肠灌肠。定期评估患者的症状、大便失禁情况及生活质量。
中位随访 12 个月后，17 例患者中有 15 例完成了研究期。所有患者均能够自行进行顺行灌肠。根据韦克斯纳量表评分系统，平均失禁评分为 7 分（满分 20 分）。平均总体健康状况评分为 78 分，身体功能为 93 分，情感功能为 88 分。6 例患者（40%）出现轻微并发症。
假可控性会阴结肠造口术加阑尾造口术在接受 APR 的低位直肠癌患者中提供了可接受的大便失禁水平以及功能和情感方面的改善。因此，这种联合方法可被视为特定患者腹部结肠造口术的一种替代方法。
