Chen Zhen-Zhou, Li Yi-Dan, Huang Wang, Chai Ning-Hui, Wei Zheng-Qiang
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
World J Gastrointest Surg. 2021 Mar 27;13(3):303-314. doi: 10.4240/wjgs.v13.i3.303.
With advancements in laparoscopic technology and the wide application of linear staplers, sphincter-saving procedures are increasingly performed for low rectal cancer. However, sphincter-saving procedures have led to the emergence of a unique clinical disorder termed anterior rectal resection syndrome. Colonic pouch anastomosis improves the quality of life of patients with rectal cancer > 7 cm from the anal margin. But whether colonic pouch anastomosis can reduce the incidence of rectal resection syndrome in patients with low rectal cancer is unknown.
To compare postoperative and oncological outcomes and bowel function of straight and colonic pouch anal anastomoses after resection of low rectal cancer.
We conducted a retrospective study of 72 patients with low rectal cancer who underwent sphincter-saving procedures with either straight or colonic pouch anastomoses. Functional evaluations were completed preoperatively and at 1, 6, and 12 mo postoperatively. We also compared perioperative and oncological outcomes between two groups that had undergone low or ultralow anterior rectal resection.
There were no significant differences in mean operating time, blood loss, time to first passage of flatus and excrement, and duration of hospital stay between the colonic pouch and straight anastomosis groups. The incidence of anastomotic leakage following colonic pouch construction was lower (11.4% 16.2%) but not significantly different than that of straight anastomosis. Patients with colonic pouch construction had lower postoperative low anterior resection syndrome scores than the straight anastomosis group, suggesting better bowel function (preoperative: 4.71 3.89, = 0.43; 1 mo after surgery: 34.2 34.7, = 0.59; 6 mo after surgery: 22.70 29.0, < 0.05; 12 mo after surgery: 15.5 19.5, = 0.01). The overall recurrence and metastasis rates were similar (4.3% and 11.4%, respectively).
Colonic pouch anastomosis is a safe and effective procedure for colorectal reconstruction after low and ultralow rectal resections. Moreover, colonic pouch construction may provide better functional outcomes compared to straight anastomosis.
随着腹腔镜技术的进步以及直线型吻合器的广泛应用，低位直肠癌保肛手术的开展越来越多。然而，保肛手术导致了一种独特的临床病症——直肠前切除综合征的出现。结肠袋吻合术可改善距肛缘>7 cm的直肠癌患者的生活质量。但结肠袋吻合术能否降低低位直肠癌患者直肠切除综合征的发生率尚不清楚。
比较低位直肠癌切除术后直结肠吻合与结肠袋肛管吻合的术后及肿瘤学结局和肠功能。
我们对72例行保肛手术（直结肠吻合或结肠袋吻合）的低位直肠癌患者进行了一项回顾性研究。术前以及术后1、6和12个月完成功能评估。我们还比较了两组接受低位或超低位直肠前切除术的围手术期和肿瘤学结局。
结肠袋吻合组与直结肠吻合组在平均手术时间、失血量、首次排气和排便时间以及住院时间方面无显著差异。结肠袋构建后吻合口漏的发生率较低（11.4% 对16.2%），但与直结肠吻合相比无显著差异。结肠袋构建患者术后低位前切除综合征评分低于直结肠吻合组，提示肠功能更好（术前：4.71对3.89，P = 0.43；术后1个月：34.2对34.7，P = 0.59；术后6个月：22.70对29.0，P<0.05；术后12个月：15.5对19.5，P = 0.01）。总体复发和转移率相似（分别为4.3%和11.4%）。
结肠袋吻合术是低位和超低位直肠切除术后结直肠重建的一种安全有效的手术方法。此外，与直结肠吻合相比，结肠袋构建可能提供更好的功能结局。
