1Department of Abdominal Surgery, Sveti Duh University Hospital, Zagreb, Croatia; 2Department of Gastroenterology, Sveti Duh University Hospital, Zagreb, Croatia; 3Department of Hematology, Dubrava University Hospital, Zagreb, Croatia; 4School of Medicine, University of Zagreb, Zagreb, Croatia; 5Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
Acta Clin Croat. 2020 Dec;59(4):703-711. doi: 10.20471/acc.2020.59.04.17.
Anterior rectal resection is a standard surgical procedure for treating carcinomas of rectum and distal sigmoid colon. In many cases of anterior rectal resection, postoperatively some level of fecal incontinence may occur. The aim of our study was to evaluate the impact of the colorectal anastomosis level on anorectal functional disorder. In our prospective study, the participants were patients diagnosed with carcinoma of rectum or distal sigmoid colon. All patients underwent standard open or laparoscopic anterior rectal resection. Six months after the surgery, the function of anorectum was evaluated in all participants. Finally, 38 patients were analyzed, including 13/38 (34.2%) patients with high rectal anastomosis, 11/38 (28.9%) with mid rectal anastomosis and 14/38 (36.8%) with low rectal anastomosis. Patients with a lower level of anastomosis had a statistically significantly greater number of stools, higher urgency and discrimination impairment, more pronounced solid, liquid and gas incontinence, and greater need for diapers (p<0.05 all). Therefore, patients with lower anastomosis had a statistically significant impairment of their quality of life and higher Wexner score (p<0.001 for both analyses). Our study results suggested reduced neorectal capacity to be the main pathophysiological factor for the development of postoperative anorectal function impairment.
直肠前切除术是治疗直肠和乙状结肠远端癌的标准手术方法。在许多直肠前切除术的病例中，术后可能会出现一定程度的粪便失禁。我们的研究目的是评估结直肠吻合口位置对肛门直肠功能障碍的影响。在我们的前瞻性研究中，参与者为被诊断为直肠或乙状结肠远端癌的患者。所有患者均接受标准的开放性或腹腔镜直肠前切除术。术后 6 个月，对所有参与者的肛门直肠功能进行评估。最终，分析了 38 例患者，其中 13/38（34.2%）例为高位直肠吻合，11/38（28.9%）例为中位直肠吻合，14/38（36.8%）例为低位直肠吻合。吻合口位置较低的患者粪便次数明显增多，排便急迫感和辨别力受损更严重，固体、液体和气体失禁更明显，对尿布的需求更大（p<0.05 均）。因此，吻合口位置较低的患者生活质量明显下降，Wexner 评分更高（p<0.001）。我们的研究结果表明，新直肠容量减少是术后肛门直肠功能障碍发展的主要病理生理因素。
