Ikeuchi H, Kusunoki M, Shoji Y, Yamamura T, Utsunomiya J
Second Department of Surgery, Hyogo College of Medicine, Japan.
Surg Today. 1997;27(8):702-5. doi: 10.1007/BF02384980.
The aim of this study was to determine the postoperative function of neorectoanal components using two different types of very low coloanal reconstruction. The two groups of patients assessed were 22 who underwent abdominal rectal resection and stapled "high" coloanal anastomosis without a pouch, being the HCAA-P group; and 34 who underwent anoabdominal rectal resection and "low" coloanal anastomosis with a colonic J-pouch, being the LCAA + P group. Manometric examination was performed 1, 3, 6, and 12 months postoperatively, and the patients were also assessed by a questionnaire. The LCAA + P group had remarkably less daily stool frequency and urgency, but there were no significant differences in the other functional parameters. Maximum resting pressure (MRP) was significantly less, while threshold volume (TV) and maximum tolerable volume (MTV) were greater in the LCAA + P group than in the HCAA-P group. The colonic J-pouch compensated for decreased MRP. Thus, when HCAA-P is performed, 3.0 cm of residual rectum with internal anal sphincter may be required, and construction of the pelvic pouch is desirable in low coloanal anastomosis.
本研究的目的是使用两种不同类型的超低位结肠肛管重建术来确定新直肠肛管组件的术后功能。评估的两组患者中，22例接受了腹部直肠切除术和无储袋的吻合器“高位”结肠肛管吻合术，为HCAA-P组；34例接受了经腹肛管直肠切除术和带结肠J形储袋的“低位”结肠肛管吻合术，为LCAA + P组。术后1、3、6和12个月进行测压检查，并通过问卷调查对患者进行评估。LCAA + P组的每日排便次数和便急症状明显较少，但在其他功能参数方面无显著差异。LCAA + P组的最大静息压（MRP）明显较低，而阈值容量（TV）和最大耐受容量（MTV）则高于HCAA-P组。结肠J形储袋补偿了MRP的降低。因此，当进行HCAA-P时，可能需要保留3.0 cm带肛门内括约肌的直肠残端，低位结肠肛管吻合术中进行盆腔储袋构建是可取的。
