Study on the effects of modified laparoscopic low rectal anastomosis on anal-rectal function
-
摘要: 目的探讨改良腹腔镜低位直肠吻合方法对术后肛门直肠功能的影响。方法回顾性收集2015年1月—2016年12月间就诊于徐州市中心医院胃肠外科并行腹腔镜直肠癌低位前切除术患者74例的临床资料。A组36例行腹腔镜直肠癌前切除术改良吻合方法，B组38例行腹腔镜直肠癌前切除术传统双吻合方法。对比2组患者的年龄、性别、肿瘤距齿状线距离、TNM分期、术前Wexner评分的差异，统计远切缘距离、吻合口高度、远端吻合环长度；并通过电话和门诊随访，采用LARS评分及Wexner评分评价肛门直肠功能。结果2组患者的年龄、性别、肿瘤距齿状线距离、TNM分期、术前Wexner评分的差异无统计学意义；改良吻合术组的吻合口高度大于传统吻合组〔(3.50±1.03)cm vs(2.87±1.10)cm，P=0.01〕，随访Wexner评分, 术后3个月（8.61±2.44 vs 10.11±2.96，P=0.02）、术后6个月（6.36±1.81 vs 7.55±2.32，P=0.02）改良吻合组统计值均优于传统吻合组。改良吻合组与常规吻合组的LARS评分术后3个月（P=0.04）、6个月（P=0.02）的符合度差异具有统计学意义。结论腹腔镜低位直肠癌改良吻合术能提高吻合口高度，减少括约肌损伤，增加对术后肛门直肠功能的保护。Abstract: ObjectiveTo explore the effects of the modified laparoscopic low rectal anastomosis on anal-rectal functions. MethodsA total of 74 patients who were admitted into our department from January 2015 to December 2016 and received laparoscopic low anterior resection were enrolled before retrospective analysis. Patients in Group A (n=36) were subject to laparoscopic anterior resection of prostate cancer through modified gastrointestinal anastomosis, while those in Group B (n=38) were provided with the traditional double anastomotic method of laparoscopic low anterior resection. Both groups were compared for age, gender, the distance from the tumor to the dentate line, TNM staging, and Wexner grading before surgery. Meanwhile, the distal margin distance, anastomotic height, and the length of distal anastomotic ring were recorded. The anal-rectal functions were evaluated through telephones and follow-up visits using the least angle regression scores (LARS) and Wexner scores. ResultsThere was no statistical significance in age, gender, the distance from the tumor to the dentate line, TNM staging, and Wexner grading before surgery between the both groups (P>0.05). The modification group showed higher anastomotic stoma height than the traditional anastomosis group (3.50±1.03 vs 2.87±1.10, P=0.01). Compared with the traditional group, the modification group produced better Wexner scores 3 months after surgery (8.61±2.44 vs 10.11±2.96, P=0.02) and 6 months after surgery (6.36±1.81 vs 7.55±2.32, P=0.02). Statistical difference was found as to LARS scores between the traditional and modification groups 3 months after surgery (P=0.04) and 6 months after surgery (P=0.02). ConclusionsThe modified laparoscopic anastomosis for low rectal carcinoma can improve anastomotic stoma height, reduce sphincter damage, and protect anal-rectal function after surgery. Key words: low rectal carcinoma; laparoscope; anal-rectal functions
-
Keywords:
- low rectal carcinoma /
- laparoscope /
- anal-rectal functions
-
-
[1] Chen TYT, Emmertsen KJ, Laurberg S. What are the best questionnaires to capture anorectal function after surgery in rectal cancer? [J]. Curr Colorectal Cancer Rep, 2014,11(1):37-43
[2] Rutter CM, Johnson EA, Feuer EJ, et al. Secular trends in colon and rectal cancer relative survival [J]. J Natl Cancer Inst, 2013,105(23):1806-1813.
[3] Bryant CL, Lunniss PJ, Knowles CH, et al. Anterior resection syndrome [J/OL]. Lancet Oncol, 2012,13(9):e403-e408. doi: 10.1016/s1470-2045(12)70236-x.
[4] Kwoun HJ, Shin YH. Impact of bowel function, anxiety and depression on quality of life in patients with sphincter-preserving resection for rectal cancer [J]. J Korean Acad Nurs, 2015,45(5):733-741.
[5] Chen TY, Wiltink LM, Nout RA, et al. Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial [J]. Clin Colorectal Cancer, 2015,14(2):106-114.
[6] Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer [J]. Ann Surg, 2012,255(5):922-928.
[7] Bretagnol F, Troubat H, Laurent C, et al. Long-term functional results after sphincter-saving resection for rectal cancer [J]. Gastroenterol Clin Biol, 2004,28(2):155-159.
[8] Wells CI, Vather R, Chu MJ, et al. Anterior resection syndrome--a risk factor analysis [J]. J Gastrointest Surg, 2015,19(2):350-359.
[9] 邓新生,王晓春,周少英,等,直肠癌超低位吻合术后排便功能及生活质量研究[J].中华临床医师杂志(电子版) ,2013,7(14):6374-6378. [10] Rouanet P, Mourregot A, Azar CC, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis [J]. Dis Colon Rectum, 2013,56(4):408-415.
[11] Fu CG, Gao XH, Wang H, et al. Treatment for early ultralow rectal cancer: pull-through intersphincteric stapled transection and anastomosis (PISTA) versus low anterior resection [J]. Tech Coloproctol, 2013,17(3):283-291.
[12] Wood DE. National Comprehensive Cancer Network (NCCN) clinical practice guidelines for lung cancer screening [J]. Thorac Surg Clin, 2015,25(2):185-197.
[13] Speake WJ, Abercrombie JF. Should ’doughnut’ histology be routinely performed following anterior resection for rectal cancer [J]. Ann R Coll Surg Engl, 2003,85(1):26-27.
[14] Rutkowski A, Nowacki MP, Chwalinski M, et al. Acceptance of a 5-mm distal bowel resection margin for rectal cancer: is it safe? [J]. Colorectal Dis, 2012,14(1):71-78.
[15] Ng CW, Lieske B, Tan KK. Routine histological sampling of doughnuts post oncologic anterior resection is not necessary [J]. Int J Colorectal Dis, 2014,29(7):843-845.
[16] Kayano H, Okuda J, Tanaka K, et al. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer [J]. Surg Endosc, 2011,25(9):2972-2979.
[17] Hiranyakas A, Ho YH. Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers: a comparative study [J]. Am J Surg, 2011,202(3):291-297.
[18] Brown SR, Mathew R, Keding A, et al. The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery [J]. Ann Surg, 2014,259(5):916-923.
[19] Romaniszyn M, Richter P, Walega P, et al. Low-anterior-resection syndrome. How does neoadjuvant radiotherapy and low resection of the rectum influence the function of anal sphincters in patients with rectal cancer? Preliminary results of a functional assessment study [J]. Pol Przegl Chir, 2012,84(4):177-183.
[20] 陈少骥,吴云云,韩善亮,等.腹腔镜下直肠低位双吻合术的改良及效果观察[J].中华胃肠外科杂志，2014,17(12):1216-1219. [21] Juul T, Ahlberg M, Biondo S, et al. International validation of the low anterior resection syndrome score [J]. Ann Surg, 2014,259(4):728-734.
计量
- 文章访问数: 1986
- HTML全文浏览量: 0
- PDF下载量: 106
下载:
.png)
