Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal, cancer: A five-year follow-up
Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal, cancer: A five-year follow-up
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DOI：
10.1007/s10350-004-0654-4
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发表时间：
2004-10-01
影响因子：
3.9
通讯作者：
Yasutomi, M
中科院分区：
文献类型：
--
作者：
Hida, J;Yoshifuji, T;Yasutomi, M
关于结肠J型袋重建的长期功能结局的报道很少，比较J型袋和直型袋重建的数据相互矛盾。这项前瞻性研究比较了直肠癌低位前切除术后5年结肠J型贮袋和直吻合术的功能结局。方法：比较46例J型贮袋重建（J组）和48例直吻合（S组）患者的功能结局。临床状态进行了评估与17项问卷调查，询问不同方面的肠功能。储血功能评价采用容积法。Fisher精确检验和Wilcoxon秩和检验分别用于比较分类和定量数据。研究结果：在超低吻合术患者中（距离肛缘小于或等于4 cm），白天排便次数（大于或等于5，4.3%对29.2%; P = 0.028）和夜间J-组中的疼痛（>1次/周，4.3%对33.3%; P = 0.013）、尿急（4.3%对33.3%; P = 0.013）和脏污（21.7%对50.0%; P = 0.043）均低于S-组。在低位吻合（距离边缘5 - 8 cm）的患者中，J组患者夜间排便次数较少（>1次/周，0 vs. 20.8%; P = 0.028），尿急较少（0 vs. 20.8%; P = 0.028）。J组的储血功能优于S组，（最大耐受容量（平均值），101.7 vs. 76.3 ml; P = 0.004;阈值容量（平均值），46.5 vs. 30.4 ml; P < 0.001;顺应性（平均值），4.9 vs. 2.5 ml/cm H2O; P < 0.001）和低吻合量组（最大耐受容量，120.4 vs. 97.9 ml; P < 0.001;阈值容量，58.3 vs. 40.8 ml; P < 0.001;顺应性，5.2 vs. 3.1 ml/cm H2O; P < 0.001）。结论：J型贮袋重建术增加了贮液囊功能，即使在术后5年，也比直吻合术提供了更好的功能结局，尤其是在吻合口距离肛门边缘小于4 cm的患者中。
Few reports on the long-term functional outcome of colonic J-pouch reconstruction have been published, and data comparing J-pouch and straight reconstruction are contradictory. This prospective study compares the functional outcome of colonic J-pouch and straight anastomosis five years after low anterior resection for rectal cancer. METHODS: Functional outcome was compared in 46 patients with J-pouch reconstruction (J-group) and 48 patients with straight anastomosis (S-group). Clinical status was evaluated with a 17-item questionnaire inquiring about different aspects of bowel function. Reservoir function was evaluated by manovolumetry. The Fisher's exact test and Wilcoxon's rank-sum test were used to compare categoric and quantitative data, respectively. RESULTS: Among patients with an ultralow anastomosis (less than or equal to4 cm from the anal verge), the number of bowel movements during the day (greater than or equal to5, 4.3 vs. 29.2 percent; P = 0.028)and at night (>1/week, 4.3 vs. 33.3 percent; P = 0.013) and urgency (4.3 vs. 33.3 percent; P = 0.013) and soiling (21.7 vs. 50.0 percent; P = 0.043) were less in the J-group than in the S-group. Among patients with a low anastomosis (5 to 8 cm from the verge), patients in the J-group had fewer bowel movements at night (>1/week, 0 vs. 20.8 percent; P = 0.028) and less urgency (0 vs. 20.8 percent; P = 0.028). Reservoir function was better in the J-group than in the S-group in both the ultralow (maximum tolerable volume (mean), 101.7 vs. 76.3 ml; P = 0.004; threshold volume (mean), 46.5 vs. 30.4 ml; P < 0.001; compliance (mean), 4.9 vs. 2.5 ml/cm H2O; P < 0.001) and low-anastomosis (maximum tolerable volume, 120.4 vs. 97.9 ml; P < 0.001; threshold volume, 58.3 vs. 40.8 ml; P < 0.001; compliance, 5.2 vs. 3.1 ml/cm H2O; P < 0.001) groups. CONCLUSIONS: J-pouch reconstruction increased reservoir function and provided better functional outcome than straight anastomosis, even five years after surgery, especially in patients whose anastomosis is less than 4 cm from the anal verge.