Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer
Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer
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DOI：
10.1007/s10350-004-0523-1
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发表时间：
2004-06-01
影响因子：
3.9
通讯作者：
Saric, J
中科院分区：
文献类型：
--
作者：
Bretagnol, F;Rullier, E;Saric, J
目的：在极低位直肠癌患者中，括约肌间切除术可保留括约肌，并具有良好的肿瘤学效果。本研究的目的是调查的功能结果和生活质量后，括约肌间切除术与传统的coloanal arterioses.METHODS：从1990年至2000年，170例患者接受全直肠系膜切除结肠肛管吻合术治疗低位直肠肿瘤。收集了77例未行结肠造口术的患者的资料：37例接受传统结肠肛门吻合术，40例接受括约肌间切除术。两组患者的年龄、性别、吻合口狭窄、结肠袋、吻合口瘘、术前放疗和随访时间（中位数，56个月）相似。评估包括一个功能和两个生活质量的问卷调查：SF-36健康状况和大便失禁的生活质量score.Results：有大便频率，碎片，紧迫性，排便困难，和消化道限制之间没有差异，患者和无括约肌间切除术。与未行括约肌间切除术的患者相比，行括约肌间切除术的患者的肛门炎明显更严重（Wexner评分，10.8比6.9; P < 0.001），需要更多的抗肛门炎药物（60%比35%; P = 0.04）。肛门括约肌间切除术后患者生活质量较传统肛门直肠病患者明显改善（P < 0.01），而SF-36量表评分无明显差异。结论：肛门括约肌间切除术后患者发生大便失禁的风险较传统肛门直肠病患者高，生活质量略有改善。
PURPOSE: The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional coloanal anastomoses.METHODS: From 1990 to 2000, 170 patients underwent total mesorectal excision with coloanal anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional coloanal anastomosis and 40 had intersphincteric resection, Both groups were similar according to age, gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score.RESULTS: There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment (P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36.CONCLUSIONS: Compared with conventional coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.