结肠J型贮袋吻合与结肠横行贮袋吻合应用于直肠癌骶前切除术的临床对比

[摘要] 目的 探讨结肠J型贮袋吻合与结肠横行贮袋吻合应用于直肠癌骶前切除术的临床对比效果。 方法 120例直肠癌患者根据手术方法的不同分为治疗组与对照组各60例，两组首先都采用直肠癌骶前切除术，然后对照组采用结肠J形贮袋吻合，治疗组采用结肠横行贮袋吻合。记录两组平均手术时间、术中输血量、住院时间、并发症发生情况及出现直肠抑制反射的几率。 结果 治疗组的平均手术时间、术中输血量和住院时间均明显少于对照组（P < 0.05）。两组并发症发生情况比较差异均无统计学意义（P > 0.05）。术后6个月，治疗组出现直肠抑制反射的几率明显高于对照组（P < 0.05）。 结论 结肠横行贮袋吻合应用直肠癌骶前切除术能有效减少创伤，促进创伤恢复，同时促进术后直肠功能的恢复。

[关键词] 结肠J型贮袋吻合；结肠横行贮袋吻合；直肠癌骶前切除术；

[中图分类号] R735.37 [文献标识码] C [文章编号] 1673-7210（2012）07（b）-0147-03

The clinical contrast between colonic J pouch anastomosis and transverse colonic pouch anastomosis for the rectal sacral anterior resection

TONG Qiang

Department of General Surgery, Pukou Hospital in Nanjing City, Jiangsu Province, Nanjing 210031, China

[Abstract] Objective To investigate the clinical contrast effects of colonic J pouch anastomosis and transverse colonic pouch anastomosis for the rectal sacral anterior resection. Methods 120 patients with rectal cancer were equally divided into the treatment group and the control group according to different surgical techniques, each group had 60 cases, all cases firstly were given rectal sacral anterior resection, and then the control group were given with colonic J-pouch anastomosis and the treatment group were given with colon transverse pouch anastomosis. The mean time of operation, intraoperative blood transfusion, hospitalization time, the complication and the risk of rectal inhibitory reflex were observed and compared. Results The mean time of operation, intraoperative blood transfusion and hospitalization time of the treatment group were significantly less than the control group (P < 0.05). The complication contrast between the two groups had no significant difference (P < 0.05). After 6 months, the risk of rectal inhibitory reflex of treatment group was significantly higher than control group (P < 0.05). Conclusion Compared with colonic J pouch surgery, colon transverse pouch anastomosis for rectal cancer sacral anterior resection can effectively reduce the trauma, promote the recovery of postoperative anorectal function.

[Key words] Colonic J pouch anastomosis; Transverse colonic pouch; Rectal sacral anterior resection; Anal

直肠癌是威胁人类健康的主要癌症之一，在我国城市试点地区已居全部恶性肿瘤的第4位，并有逐年上升的趋势。据WHO的报告，我国直肠癌死亡率2005年比1991年增加了70.7%，年均增加4.7%。直肠癌的化学与放射治疗多用于直肠癌手术前后的辅助治疗，其用于直肠癌术前，虽不能改善患者的生存率，但可在一定程度上缩小瘤体，有利于手术切除和保留括约肌的功能，并且可减少术中和术后肿瘤扩散的机会；而多项研究显示术后采用足量的联合化疗，可提高患者的生存率。但因多数患者术后身体较弱，难以忍受化疗的毒副作用，临床上多结合生物免疫治疗，以减轻其毒副作用。外科手术切除一直是最有效的治疗方法[1]。随着社会的进步，对生活质量要求的提高，直肠癌的流行病学特点使得保留手术被广泛接受。如果能在术前根据患者的功能评估情况预测手术后功能恢复情况，选择合适的手术方式，将使直肠癌的临床治疗决策更全面、安全、有效[2-3]。而结肠横行贮袋容量较大，可以避免直接吻合术后早期控便功能问题，而且可以避免结肠J形贮袋术后晚期大便排空问题[4-5]。本文为此具体探讨了结肠横行贮袋吻合应用于直肠癌骶前切除术的临床应用效果，现报道如下：