Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis
Prospective, randomized study comparing clinical results between small and large colonic J-pouch following coloanal anastomosis
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DOI：
10.1007/bf02070703
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发表时间：
1997-12-01
影响因子：
3.9
通讯作者：
Muhammad, S
中科院分区：
文献类型：
--
作者：
Lazorthes, F;Gamagami, R;Muhammad, S
目的：结肠吻合术后构建结肠 J 型袋可以获得改善的功能结果。在当前的文献中，结肠肛门吻合术后造口袋尺寸的变化是普遍存在的。在这项研究中，作者比较了直肠癌患者使用小型 Gem 或大型 10 厘米结肠 J 袋吻合术进行完全直肠切除和结肠肛管吻合术后的临床肠道功能。在短期和长期随访中评估临床结果。方法：连续 59 名距肛缘 4 至 8 厘米的直肠癌患者被纳入研究。术中将患者随机分为 Gem J 袋组或 10 厘米 J 袋组。在结肠造口闭合后的术后 3、6、12 和 24 个月进行前瞻性临床评估。评估并比较两组之间的临床参数，例如频率、紧迫性、节制以及泻药和灌肠的使用。结果：3、6、12和24个月时，两组的平均排便频率、紧迫性和大便控制没有统计学差异。第一年，两组之间泻药和灌肠剂的使用量可以忽略不计；然而，两年后，30% 的大储囊患者和小储袋组的 10% 患者需要泻药和/或灌肠剂来治疗便秘和排便。结论：无论是小水库还是大水库的患者在一年内都可以预期获得类似的临床结果。然而，随着长期随访，储库较大的患者更有可能需要药物治疗便秘和排便。为了避免这些不便，建议接受结肠肛门吻合术的患者使用小型储液器。
PURPOSE: 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 Gem or a large 10-cm colonic J-pouch anastomosis. The clinical outcome is assessed both at short-term and long-term follow-up. METHODS: 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 Gem 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. RESULTS: 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. CONCLUSION: 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.