Floodeen Hannah, Lindgren Rickard, Hallböök Olof, Matthiessen Peter
1Department of Surgery, Örebro University Hospital, Örebro, Sweden 2Department of Surgery, Linköping University Hospital, Linköping, Sweden 3Örebro University, Örebro, Sweden.
Dis Colon Rectum. 2014 Oct;57(10):1162-8. doi: 10.1097/DCR.0000000000000197.
Anorectal function after rectal surgery with low anastomosis is often impaired. Outcome of long-term anorectal function is poorly understood but may improve over time.
We evaluated anorectal function 5 years after low anterior resection for cancer with regard to whether patients had a temporary stoma at initial resection. The objective of this study was to assess changes in anorectal function over time by comparing the results with anorectal function 1 year after rectal resection.
This study was a secondary end point of a randomized, multicenter controlled trial.
The study was conducted at 21 Swedish hospitals performing rectal cancer surgery from 1999 to 2005.
Patients included were those operated on with low anterior resection.
Patients were randomly assigned to receive or not receive a defunctioning stoma.
We evaluated anorectal function in patients who were initially randomly assigned to the defunctioning stoma or no stoma group, who had been free of stoma for 5 years, by means of using a standardized patient questionnaire. Questions addressed stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and patient preference regarding permanent stoma formation. Results were compared with the same patient cohort at 1-year follow-up.
A total of 123 patients answered the bowel function questionnaire (65 in the no-stoma group and 58 in the stoma group). No differences were found between groups regarding the number of passed stools, need for medication to open the bowel, evacuation difficulties, incontinence, and urgency. General well-being was significantly better in the no-stoma group (p = 0.033). Comparison with anorectal function at 1 year showed no further changes over time.
The study was based on a limited sample size (n = 123) and formed a secondary end point of a randomized trial.
Anorectal function was impaired for many patients, but the temporary presence of a defunctioning stoma after rectal resection did not affect long-term outcome. Anorectal function did not change between 1-year and 5-year follow-up.
低位吻合直肠手术后的肛门直肠功能常受损。长期肛门直肠功能的结果了解甚少，但可能会随时间改善。
我们评估了低位前切除术治疗癌症5年后的肛门直肠功能，观察患者初次切除时是否有临时造口。本研究的目的是通过将结果与直肠切除术后1年的肛门直肠功能进行比较，评估肛门直肠功能随时间的变化。
本研究是一项随机、多中心对照试验的次要终点。
该研究在1999年至2005年期间进行直肠癌手术的21家瑞典医院开展。
纳入的患者为接受低位前切除术的患者。
患者被随机分配接受或不接受去功能化造口。
我们通过使用标准化患者问卷，评估了最初随机分配到去功能化造口组或无造口组且已无造口5年的患者的肛门直肠功能。问题涉及大便频率、急迫感、排便碎片化、排便困难、失禁、生活方式改变以及患者对永久性造口形成的偏好。结果与同一患者队列1年随访时的情况进行比较。
共有123名患者回答了肠道功能问卷（无造口组65名，造口组58名）。两组在排便次数、使用通便药物的需求、排便困难、失禁和急迫感方面未发现差异。无造口组的总体幸福感明显更好（p = 0.033）。与1年时的肛门直肠功能比较，未发现随时间有进一步变化。
该研究基于有限的样本量（n = 123），且是一项随机试验的次要终点。
许多患者的肛门直肠功能受损，但直肠切除术后临时存在去功能化造口并不影响长期结局。1年和5年随访期间肛门直肠功能未发生变化。
