Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection
Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection
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直肠括约肌间切除术后结肠J型袋重建与直肠结肠吻合术的比较
DOI：
10.1007/s004230100214
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
V. Schumpelick
中科院分区：
文献类型：
--
作者：
S. Willis;R. Kasperk;J. Braun;V. Schumpelick
远端直肠癌保肛切除的趋势导致了低位前切除术后直结肠肛管吻合术（CAA）和结肠J型袋肛管吻合术（CPA）。本研究的目的是比较超低位括约肌间切除术后两种重建方式的并发症发生率、肛门直肠生理和功能结果。共31例接受CPA的患者进行了前瞻性随访，使用肛门直肠测压和标准化问卷，并与63例接受CAA的患者进行了比较，并以同样的方式进行了随访。CPA术后并发症发生率与CAA术后无显著差异。术后1年，CPA术后排便次数和尿急中位数均降低（1.7±2.2次/天; 7% vs. 2.4±3.6次/天; 14%;P<0.05）。结肠/回肠造口关闭后3个月，CAA后最大耐受容量、阈值容量和顺应性较CPA后降低（分别为55±12、34±12和3.9± 0.3ml/mmHg vs. 85±21、53±11和6.2ml/mmHg;P<0.05）。肛门测压显示肛门静息压和挤压压无显著差异。术后一年，CPA和CAA之间的平均动脉压也没有显著差异。结肠J形袋重建术似乎比直结肠肛管吻合术优越上级，尤其是在术后第一年。鉴于患者的预后往往很差，它是超低位直肠切除术后重建的首选。
The tendency towards sphincter-preserving resection for distal rectal cancers has led to the technique of straight coloanal anastomosis (CAA) and colonic J-pouch anal anastomosis (CPA) after low anterior resection. The aim of the present study was to compare complication rate, anorectal physiology and functional results after both types of reconstruction after ultra-low intersphincteric resection. A total of 31 patients who had undergone CPA were followed up prospectively using anorectal manometry and a standardised questionnaire and were compared with 63 patients who had undergone CAA and were followed up in the same way. The complication rate after CPA did not differ significantly from that after CAA. One year postoperatively, the median stool frequency and urgency were reduced after CPA (1.7±2.2/day; 7% vs. 2.4±3.6/day; 14%;P<0.05). Three months after colostomy/ileostomy closure, the maximum tolerable volume, threshold volume and compliance were decreased after CAA when compared with CPA (55±12, 34±12, and 3.9±0.3 ml/mmHg vs. 85±21, 53±11 and 6.2 ml/mmHg, respectively;P<0.05). Anal manometry revealed no significant differences in the anal resting and squeeze pressure. One year postoperatively, continence also did not differ significantly between CPA and CAA. Colonic J-pouch reconstruction seems to be superior to the straight coloanal anastomosis, especially during the first postoperative year. In view of the often poor prognosis of the patients, it is the reconstruction of choice after ultra-low resections of the rectum.
影响因子：
9.6
作者：
HEALD, RJ;HUSBAND, EM;RYALL, RDH
通讯作者：
RYALL, RDH