Chew S B, Tindal D S
Illawarra Area Health Service, Wollongong, New South Wales, Australia.
Aust N Z J Surg. 1997 Sep;67(9):607-10. doi: 10.1111/j.1445-2197.1997.tb04607.x.
Sphincter-saving procedures are now commonly used for low rectal cancer but straight colo-anal anastomosis seemed to produce poor functional outcome. The present study was therefore carried out to compare and contrast the functional outcome of colonic J-pouch and straight colo-anal anastomosis.
The clinical and functional outcome of 17 patients having a colonic J-pouch-anal anastomosis and 10 patients having a straight colo-anal anastomosis were compared. They were compared in terms of age, sex, distal resection margin, Dukes stage, histological grade, morbidity/mortality and postoperative anal function.
There was better bowel function in patients having J-pouch-anal anastomosis, especially in the early period after closure of the covering stoma. Bowel frequency in those patients who had a J-pouch anastomosis was much less compared to those patients in the straight colo-anal group in the 1st and possibly the 2nd year. There was a period of adaptation for the straight colo-anal group which led to a bowel frequency approaching that of the J-pouch group over 1-2 years. Differences in urgency, faecal continence, evacuation function, the use of drugs to slow bowel frequency and ability to discriminate between flatus and faeces were found to favour the J-pouch group in the first postoperative year. The difference between the two groups diminished after that because the straight group improved, especially by the end of the 2nd year. During the study period, there were no constipation problems in the J-pouch group, as noted in some other studies. This was probably associated with the 6-cm length chosen for the pouch.
The use of colonic J-pouch resulted in a significant decrease in stool frequency and more satisfactory anal function for the first postoperative year. This difference lessened during the second postoperative year. There was no demonstrable difficulty with rectal evacuation in the pouch patients.
保肛手术目前常用于低位直肠癌，但直结肠肛管吻合术的功能预后似乎较差。因此，本研究旨在比较和对比结肠J袋与直结肠肛管吻合术的功能预后。
比较了17例行结肠J袋肛管吻合术患者和10例行直结肠肛管吻合术患者的临床和功能预后。比较了两组患者的年龄、性别、远端切缘、Dukes分期、组织学分级、发病率/死亡率及术后肛门功能。
行结肠J袋肛管吻合术的患者肠道功能更好，尤其是在覆盖造口关闭后的早期。在术后第1年甚至可能是第2年，行J袋吻合术患者的排便次数远少于直结肠肛管吻合术组患者。直结肠肛管吻合术组有一段适应期，1 - 2年后排便次数接近J袋组。在术后第1年，发现J袋组在便急、粪便失禁、排空功能、使用减缓排便次数药物以及区分屁和粪便的能力方面更具优势。两组之间的差异在那之后减小，因为直结肠肛管吻合术组有所改善，尤其是在第2年末。在研究期间，J袋组没有出现便秘问题，其他一些研究曾有提及。这可能与所选用的6厘米长的J袋有关。
结肠J袋的使用使术后第1年的排便次数显著减少，肛门功能更令人满意。这种差异在术后第2年有所减小。J袋患者在直肠排空方面未发现明显困难。
