• 四川大學(xué)華西醫(yī)院普外科(成都 610041);

目的  評價低位直腸癌低位吻合術(shù)后排便功能的康復(fù)效果。
方法  對541例低位直腸癌用雙吻合器技術(shù)進行低位或者超低位Dixon手術(shù)病人的術(shù)后排便功能進行隨訪,并以徐忠發(fā)五項十分制評價標(biāo)準(zhǔn),結(jié)合肛門指征、吻合口位置、術(shù)后時間進行綜合分析評價。手術(shù)后對患者立即進行排便功能訓(xùn)練和康復(fù)指導(dǎo),同時應(yīng)用藥物協(xié)助排便。
結(jié)果  術(shù)后1個月,低位Dixon排便功能優(yōu)75.9%(211/278)、良11.9%(33/278)、一般10.1%(28/278)、差2.2%(6/278),超低位Dixon排便功能優(yōu)70.7%(186/263)、良13.3%(35/263)、一般10.7%(28/263)、差5.3%(14/263),經(jīng)秩和檢驗差異無統(tǒng)計學(xué)意義(Z= –1.429, P=0.136),但是便意(Z= –4.610, P=0.000)、排便感覺差異有統(tǒng)計學(xué)意義(Z= –5.252, P=0.000)。病人接受了6個月的肛門及排便功能訓(xùn)練和指導(dǎo)后,低位Dixon組與超低位Dixon組排便功能差異無統(tǒng)計學(xué)意義(Z= –0.550, P=0.582)。
結(jié)論  在護理指導(dǎo)下,行低位或超低位Dixon手術(shù)病人的排便功能無差異。

引用本文: 陳增蓉,李卡,印義瓊. 直腸癌低位吻合術(shù)后遠(yuǎn)期排便功能評價. 中國循證醫(yī)學(xué)雜志, 2007, 07(3): 175-179. doi: 復(fù)制

1. Xu ZF, Zuo WS, Liu Q. Editor in chief. Modern Surgery for Rectal Tumor. 1st edition. Jinan: Shandong Science and Technology Press, 1993. 258–261.
2. Zhang QR. Clinical Anus-Large Intestine Surgery. 1st edition. Tianjing: Tianjing Science and Technology Translation and Publishing Corporation, 1991. 21.
3. Luo YS. Cause and treatment for postoperative local recurrence of rectal carcinoma. Chinese Journal of Coloproctology, 2002, 22(10): 21.
4. Zhang YJ. Pull-through Welch procedure in the ultralow resection for treating Low/Ultralow rectal carcinoma. Chinese Journal of Coloproctology, 2001, 21(10): 15.
5. Guo P, Zhang WP, Yan TZ, et al. A transabdominal-hiatal approach of anal canal anastomoses after resection of ultralow rectal carcinoma. Nat Med J Chin, 2000, 80(6): 453.
6. Vauthey JN, Marsh RW, Zlotecki RA, et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg, 1999, 229(5): 745–752; discussion 752–754.
7. Andreola S, Leo E, Belli F, et al. Adenocarcinoma of the lower third of the rectum surgically treated with a <10-mm distal clearance: Preliminary results in 35_patients. Ann Surg Oncol, 2001, 8(7): 611–615.
8. Park YJ, Youk EG, Choi HS, et al. Experience of 1446 rectal cancer patients in Korea and analysis of prognostic factors. Int J Colorect Dis, 1999, 14(2): 101–106.
9. 徐忠發(fā), 左文述, 劉奇. 主編. 現(xiàn)代肛腸腫瘤外科學(xué). 第1版. 濟南:山東科學(xué)技術(shù)出版社, 1993. 258~261.
10. 森田 隆幸, 村田 嘵彥, 小山 基, 他. 直腸癌に對する門括筋機能溫存手術(shù). 消化器外科, 2003, 26: 327~334.
11. Parks AG. Pesection and suturd coloanal anastomosis for rdctal carcinoma. Br J Surg, 1982, 69(6): 301–304.
12. 張慶榮. 臨床肛門大腸外科學(xué). 第1版. 天津: 天津科技翻譯出版公司, 1991. 21.
13. 佐治重豐, 車修次, 橋本俊幸. 直腸癌にする超低位直腸前方切除術(shù).臨床外科, 1993, 48(9): 1177~1779.
14. 羅運生. 直腸癌術(shù)后局部復(fù)發(fā)原因和治療. 中國肛腸病雜志, 2002, 22(10): 21.
15. 張云杰. 拖出式Welch法超地位切除術(shù)治療中下段直腸癌. 中國肛腸病雜志, 2001, 21(10): 15.
16. 郭澎, 張維平, 顏廷忠, 等. 經(jīng)腹低位直腸癌切除結(jié)腸肛管吻合術(shù)的應(yīng)用研究. 中華醫(yī)學(xué)雜志, 2000, 80(6): 453.
  1. 1. Xu ZF, Zuo WS, Liu Q. Editor in chief. Modern Surgery for Rectal Tumor. 1st edition. Jinan: Shandong Science and Technology Press, 1993. 258–261.
  2. 2. Zhang QR. Clinical Anus-Large Intestine Surgery. 1st edition. Tianjing: Tianjing Science and Technology Translation and Publishing Corporation, 1991. 21.
  3. 3. Luo YS. Cause and treatment for postoperative local recurrence of rectal carcinoma. Chinese Journal of Coloproctology, 2002, 22(10): 21.
  4. 4. Zhang YJ. Pull-through Welch procedure in the ultralow resection for treating Low/Ultralow rectal carcinoma. Chinese Journal of Coloproctology, 2001, 21(10): 15.
  5. 5. Guo P, Zhang WP, Yan TZ, et al. A transabdominal-hiatal approach of anal canal anastomoses after resection of ultralow rectal carcinoma. Nat Med J Chin, 2000, 80(6): 453.
  6. 6. Vauthey JN, Marsh RW, Zlotecki RA, et al. Recent advances in the treatment and outcome of locally advanced rectal cancer. Ann Surg, 1999, 229(5): 745–752; discussion 752–754.
  7. 7. Andreola S, Leo E, Belli F, et al. Adenocarcinoma of the lower third of the rectum surgically treated with a <10-mm distal clearance: Preliminary results in 35_patients. Ann Surg Oncol, 2001, 8(7): 611–615.
  8. 8. Park YJ, Youk EG, Choi HS, et al. Experience of 1446 rectal cancer patients in Korea and analysis of prognostic factors. Int J Colorect Dis, 1999, 14(2): 101–106.
  9. 9. 徐忠發(fā), 左文述, 劉奇. 主編. 現(xiàn)代肛腸腫瘤外科學(xué). 第1版. 濟南:山東科學(xué)技術(shù)出版社, 1993. 258~261.
  10. 10. 森田 隆幸, 村田 嘵彥, 小山 基, 他. 直腸癌に對する門括筋機能溫存手術(shù). 消化器外科, 2003, 26: 327~334.
  11. 11. Parks AG. Pesection and suturd coloanal anastomosis for rdctal carcinoma. Br J Surg, 1982, 69(6): 301–304.
  12. 12. 張慶榮. 臨床肛門大腸外科學(xué). 第1版. 天津: 天津科技翻譯出版公司, 1991. 21.
  13. 13. 佐治重豐, 車修次, 橋本俊幸. 直腸癌にする超低位直腸前方切除術(shù).臨床外科, 1993, 48(9): 1177~1779.
  14. 14. 羅運生. 直腸癌術(shù)后局部復(fù)發(fā)原因和治療. 中國肛腸病雜志, 2002, 22(10): 21.
  15. 15. 張云杰. 拖出式Welch法超地位切除術(shù)治療中下段直腸癌. 中國肛腸病雜志, 2001, 21(10): 15.
  16. 16. 郭澎, 張維平, 顏廷忠, 等. 經(jīng)腹低位直腸癌切除結(jié)腸肛管吻合術(shù)的應(yīng)用研究. 中華醫(yī)學(xué)雜志, 2000, 80(6): 453.