Paty P B, Enker W E, Cohen A M, Minsky B D, Friedlander-Klar H
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Am J Surg. 1994 Jan;167(1):90-4; discussion 94-5. doi: 10.1016/0002-9610(94)90058-2.
In a survey of patients treated with coloanal anastomosis for rectal cancer, 81 of 90 eligible patients responded to a questionnaire evaluating current anorectal function. Time from operation to assessment ranged from 1.3 to 12.3 years (median: 4.3 years). The median stool frequency was two per day; 22% of patients reported four or more stools per day. In the patients surveyed, fecal continence was complete in 51%, incontinence to gas only in 21%, minor leak in 23%, and significant leak in 5%. Complete evacuation of the neorectum was problematic in 32%. Overall function was excellent in 28%, good in 28%, fair in 32%, and poor in 12%. The impact of treatment variables on functional outcome was assessed by univariate and multivariate analyses. No surgical technique correlated with improved or impaired outcome. Time since surgery (reduced stool frequency) and use of postoperative adjuvant radiotherapy (increased stool frequency, increased difficulty with evacuation) did appear to influence functional outcome. We conclude that the functional results of coloanal anastomosis are good but not optimal. Continued investigation of the effects of surgical technique and adjuvant therapy is warranted.
在一项针对接受直肠癌结肠肛管吻合术治疗患者的调查中,90例符合条件的患者中有81例回复了一份评估当前肛门直肠功能的问卷。从手术到评估的时间为1.3至12.3年(中位数:4.3年)。大便频率中位数为每天两次;22%的患者报告每天排便四次或更多。在接受调查的患者中,51%的患者大便完全自控,21%的患者仅存在气体失禁,23%的患者有轻微渗漏,5%的患者有明显渗漏。32%的患者新直肠完全排空存在问题。总体功能优秀的占28%,良好的占28%,中等的占32%,差的占12%。通过单因素和多因素分析评估治疗变量对功能结果的影响。没有手术技术与改善或受损的结果相关。术后时间(大便频率降低)和术后辅助放疗的使用(大便频率增加、排空困难增加)似乎确实会影响功能结果。我们得出结论,结肠肛管吻合术的功能结果良好但并非最佳。有必要继续研究手术技术和辅助治疗的效果。