Analysis of the clinical factors associated with anal function after intersphincteric resection for very low rectal cancer.
Analysis of the clinical factors associated with anal function after intersphincteric resection for very low rectal cancer.
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DOI：
10.1186/1477-7819-11-24
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发表时间：
2013-01-28
影响因子：
3.2
通讯作者：
Sugiura F
中科院分区：
文献类型：
--
作者：
Tokoro T;Okuno K;Hida J;Ueda K;Yoshifuji T;Daito K;Takemoto M;Sugiura F
括约肌间切除术（ISR）已被用于避免极低位直肠癌患者的永久性结肠造口术。本研究旨在评估ISR的手术安全性以及肿瘤学和功能结局。回顾性分析了30例接受ISR而未接受新辅助治疗的连续极低位直肠癌患者的记录;采用Kaplan-Meier方法计算生存率和局部复发率。通过功能问卷和Wexner评分评估Increased。齿状线远端边缘之间的中位距离为10 mm。分别有12例、4例和14例患者接受了部分ISR、次全ISR和全ISR。所有病例远端切缘均为阴性，2例环周切缘为阳性。死亡率为33.3%：7例患者发生吻合口狭窄，2例患者发生结肠J型袋脱垂，1例患者发生肛门阴道瘘。在中位数为56.2个月的随访期间，分别有4例、3例和2例患者发生局部复发、远处复发和合并复发。5年总生存率和无病生存率分别为76.5%和68.4%。Tis-T2肿瘤患者的局部复发率为5.2%，而T3肿瘤患者的局部复发率为45.5%（P = 0.008）。19例患者造口闭合后12个月的平均Wexner评分和大便频率分别为11.5和6.6/24 h。部分ISR和小计/总ISR之间的Wexner评分无显著差异（11.8 ± 2.6和9.1 ± 5.6）。吻合口狭窄患者的排便频率（P = 0.02）、尿急（P = 0.04）和碎裂（P = 0.015）比无吻合口狭窄患者更差;吻合口狭窄患者的症状无改善。ISR患者的吻合口狭窄可能对肛门功能产生负面影响。对于全部ISR患者，至少需要知情同意书，说明永久性结肠造口术的可能性。
Intersphincteric resection (ISR) has been used to avoid permanent colostomy in very low rectal cancer patients. This study aimed to assess the surgical safety and oncologic and functional outcomes of ISR. The records of 30 consecutive very low rectal cancer patients who underwent ISR without neoadjuvant therapy were retrospectively analyzed; survival and locoregional recurrence rates were calculated by the Kaplan-Meier method. Incontinence was assessed by a functionality questionnaire and the Wexner score. The median distance between the distal margin of the dentate line was 10 mm. A total of 12, 4, and 14 patients underwent partial ISR, subtotal ISR, and total ISR, respectively. The mean distal resection margin was negative in all cases, and circumferential resection margin was positive in two cases. Morbidity was 33.3%: anastomotic stricture in seven patients, colonic J-pouch prolapse in two patients, and an anovaginal fistula in one patient. During the median, 56.2-month follow-up period, local, distant, and combined recurrences occurred in four, three, and two patients, respectively. The 5-year overall and disease-free survival rates were 76.5% and 68.4%, respectively. Local recurrence rates were 5.2% for the patients with Tis-T2 tumors as compared with 45.5% for those with T3 tumors (P = 0.008). The mean Wexner scores and stool frequencies, 12 months after stoma closure in 19 patients, were 11.5 and 6.6 per 24 h, respectively. Significant differences were not seen in the Wexner scores between partial ISR and subtotal/total ISR (11.8 ± 2.6 and 9.1 ± 5.6). Stool frequency (P = 0.02), urgency (P = 0.04), and fragmentation (P = 0.015) were worse in patients with anastomotic stricture than in those without; there was no symptom improvement in patients with anastomotic stricture. The anastomotic strictures in patients undergoing ISR may have negatively affected anal function. For total ISR patients, at least, informed consent stating the possibility of a permanent colostomy is necessary.
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影响因子：
3.9
作者：
Dennett, ER;Parry, BR
通讯作者：
Parry, BR
影响因子：
3.9
作者：
Rullier, E;Zerbib, F;Parneix, M
通讯作者：
Parneix, M
DOI：
10.1046/j.1463-1318.2003.00508.x
发表时间：
2003-09-01
期刊：
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
影响因子：
--
作者：
Tiret, E;Poupardin, B;Parc, R
通讯作者：
Parc, R
影响因子：
3.9
作者：
Berger, A;Tiret, E;Parc, R
通讯作者：
Parc, R
影响因子：
3.9
作者：
Hida, J;Yoshifuji, T;Yasutomi, M
通讯作者：
Yasutomi, M