Lazorthes F, Gamagami R, Chiotasso P, Istvan G, Muhammad S
Department of General and Digestive Surgery, Purpan Hospital, Toulouse, France.
Dis Colon Rectum. 1997 Dec;40(12):1409-13. doi: 10.1007/BF02070703.
Improved functional results can be obtained by construction of a colonic J-pouch after coloanal anastomosis. Variability in pouch size following coloanal anastomosis is prevalent in current literature. In this study, the authors compare clinical bowel function after complete rectal excision with coloanal anastomosis for patients with rectal carcinoma using either a small 6-cm or a large 10-cm colonic J-pouch anastomosis. The clinical outcome is assessed both at short-term and long-term follow-up.
Fifty-nine consecutive patients with rectal cancers 4 to 8 cm from the anal verge were recruited into the study. Patients were randomized intraoperatively to either a 6-cm J-pouch group or a 10-cm J-pouch group. Clinical assessments were performed prospectively at 3, 6, 12, and 24 months postoperatively, following colostomy closure. Clinical parameters such as frequency, urgency, continence, and laxative and enema use were assessed and compared between the two groups.
There was no statistical differences in the mean defecation frequency, urgency, and fecal continence between the two groups at 3, 6, 12, and 24 months. In the first year, laxative and enema use between the two groups was negligible; however at two years, 30 percent of patients with a large reservoir compared with 10 percent of patients in the small-pouch group required laxative and/or enema for constipation and evacuation of bowels.
Similar clinical results can be expected from patients with either small or large reservoirs at one year. However, with long-term follow-up, patients with a large reservoir are more likely to require medication for constipation and evacuation. To avoid these inconveniences a small reservoir is advocated for patients undergoing coloanal anastomosis.
经结肠肛管吻合术构建结肠J形贮袋可改善功能结果。目前的文献中，结肠肛管吻合术后贮袋大小存在差异。在本研究中，作者比较了直肠癌患者行全直肠切除及结肠肛管吻合术时，使用6厘米小结肠J形贮袋吻合术和10厘米大结肠J形贮袋吻合术的临床肠道功能。在短期和长期随访中评估临床结果。
连续纳入59例距肛缘4至8厘米的直肠癌患者进行研究。患者在术中随机分为6厘米J形贮袋组或10厘米J形贮袋组。术后在结肠造口关闭后的3、6、12和24个月进行前瞻性临床评估。评估并比较两组的临床参数，如排便频率、急迫感、控便能力以及泻药和灌肠剂的使用情况。
两组在术后3、6、12和24个月时，平均排便频率、急迫感和粪便失禁方面无统计学差异。在第一年，两组使用泻药和灌肠剂的情况可忽略不计；然而在两年时，大贮袋组30%的患者与小贮袋组10%的患者因便秘和排便需要使用泻药和/或灌肠剂。
一年时，无论贮袋大小，患者的临床结果相似。然而，长期随访发现，大贮袋患者更可能因便秘和排便需要用药。为避免这些不便，对于接受结肠肛管吻合术的患者，提倡使用小贮袋。
