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首页> 外文期刊>Surgery today >Clinical and functional comparison between stapled colonic J-pouch low rectal anastomosis and hand-sewn colonic J-pouch anal anastomosis for very low rectal cancer.
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Clinical and functional comparison between stapled colonic J-pouch low rectal anastomosis and hand-sewn colonic J-pouch anal anastomosis for very low rectal cancer.

机译：极低位直肠癌的吻合式结肠J袋低位直肠吻合术与手工缝制的结肠J袋式肛门吻合术的临床和功能比较。

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PURPOSE: We investigated intersphincteric resection with hand-sewn coloanal anastomosis, which may be an alternative to standard low anterior resection for very low rectal cancer when stapled anastomosis is technically impossible. METHODS: The present study compared the clinical and functional results of 16 patients who underwent stapled colonic J-pouch low rectal anastomosis (CJLRA) with those of 15 patients who underwent intersphincteric excision and hand-sewn colonic J-pouch anal anastomosis (CJAA). RESULTS: After a median follow-up period of 59 months, local recurrence was found in four patients from the CJAA group, three of whom subsequently underwent curative abdominoperineal resection. Defecatory function 6 and 12 months after surgery did not differ between the groups, although pads were used significantly more frequently in the CJAA group. Anorectal physiologic study before and 12 months after surgery revealed that the internal anal sphincter function was impaired to a larger extent after CJAA than after CJLRA, probably due to the partial or subtotal resection of the internal sphincter, and the anal dilatation during resection and anastomosis. CONCLUSION: Although the prevention of intraoperative tumor implantation and the early detection of local recurrence is of utmost importance, CJAA may be an acceptable sphincter-preserving procedure for selected patients in whom stapled anastomosis is impossible.
机译：目的：我们研究了人工缝合结肠吻合术的括约肌间切除术，这在技术上不可能进行吻合吻合术时可以替代非常低位直肠癌的标准低位前切除术。方法：本研究比较了16例行大肠结肠J型袋低位直肠吻合术（CJLRA）和15例行括约肌切除和手工缝制的大肠J型袋肛门吻合术（CJAA）的临床和功能结果。结果：在中位随访期59个月后，CJAA组的4例患者发现了局部复发，其中3例随后接受了根治性腹膜手术。术后6个月和12个月的排便功能在两组之间没有差异，尽管在CJAA组中使用垫的频率更高。术前和术后12个月的肛门直肠生理研究表明，CJAA后肛门内括约肌功能受损的程度比CJLRA后更大，这可能是由于内括约肌的部分或次全切除以及切除和吻合术中肛门扩张引起的。结论：尽管预防术中肿瘤植入和早期发现局部复发至关重要，但是对于无法进行吻合钉吻合术的某些患者，CJAA可能是可以接受的保留括约肌的方法。

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