Benoist S, Panis Y, Boleslawski E, Hautefeuille P, Valleur P
Department of Surgery, Lariboisière Hospital, Paris, France.
J Am Coll Surg. 1997 Aug;185(2):114-9. doi: 10.1016/s1072-7515(97)00016-1.
The aim of this study was to compare retrospectively the longterm functional results of straight or J-pouch coloanal anastomosis and low colorectal anastomosis in patients operated for rectal carcinoma.
Of the 260 patients who underwent rectal resection for carcinoma in our department during a 12-year period, 105 were included in this study. Of these, 37 had straight coloanal, 15 J-pouch coloanal, and 53 low colorectal anastomoses.
At 1 year of followup, continence was significantly better after low colorectal than straight coloanal anastomosis (perfect continence: 81% versus 51%; p < 0.01). No significant difference was observed for continence after J-pouch coloanal and low colorectal anastomosis. Stool frequency during a 24-hour period was significantly higher after straight coloanal anastomosis than after either J-pouch coloanal (p < 0.05) or low colorectal anastomosis (p < 0.01). Night stools were significantly more frequent after straight than J-pouch coloanal anastomosis (p < 0.05). Three years after surgery, continence had improved in the three groups, as 70% of the straight coloanal group, 91% of the J-pouch coloanal group, and 94% of the colorectal anastomosis group had perfect continence (p < 0.02 versus straight coloanal anastomosis). No significant difference for continence was observed between the J-pouch coloanal and low colorectal anastomosis groups. Neither were significant differences observed among the three groups for urgency, gas/stool discrimination, stool frequency (including night stools), or the need for medication.
The functional results of both J-pouch coloanal and low stapled colorectal anastomosis seem better than those of straight coloanal anastomosis. Both J-pouch and low-stapled procedures can safely be proposed for patients with rectal carcinoma requiring total mesorectal rectal excision; however, because low stapled colorectal anastomosis seems to us easier and faster to perform, we consider it the best option for rectal reconstruction after proctectomy for carcinoma, provided it is possible based on the level of the tumor.
本研究的目的是回顾性比较直肠癌手术患者行直结肠肛管吻合术或J形贮袋结肠肛管吻合术与低位结直肠吻合术的长期功能结果。
在我们科室12年期间接受直肠癌切除术的260例患者中，105例纳入本研究。其中，37例行直结肠肛管吻合术，15例行J形贮袋结肠肛管吻合术，53例行低位结直肠吻合术。
随访1年时，低位结直肠吻合术后的控便能力明显优于直结肠肛管吻合术（完全控便：81%对51%；p<0.01）。J形贮袋结肠肛管吻合术与低位结直肠吻合术后的控便能力无显著差异。直结肠肛管吻合术后24小时内的排便频率明显高于J形贮袋结肠肛管吻合术（p<0.05）或低位结直肠吻合术（p<0.01）。直结肠肛管吻合术后的夜间排便频率明显高于J形贮袋结肠肛管吻合术（p<0.05）。术后3年，三组的控便能力均有所改善，直结肠肛管吻合术组70%、J形贮袋结肠肛管吻合术组91%、结直肠吻合术组94%达到完全控便（与直结肠肛管吻合术相比，p<0.02）。J形贮袋结肠肛管吻合术组与低位结直肠吻合术组的控便能力无显著差异。三组在尿急、气体/粪便辨别、排便频率（包括夜间排便）或用药需求方面也无显著差异。
J形贮袋结肠肛管吻合术和低位吻合器结直肠吻合术的功能结果似乎均优于直结肠肛管吻合术。对于需要行全直肠系膜直肠切除术的直肠癌患者，J形贮袋和低位吻合器手术均可安全推荐；然而，由于低位吻合器结直肠吻合术在我们看来操作更简便、更快，我们认为对于癌性直肠切除术后的直肠重建，只要根据肿瘤位置可行，它就是最佳选择。
