CAJ | 학술논문

目的：通过分析吻合口水平对肛门排便功能和生活质量的影响，探讨直肠癌超低位吻合保肛极限。方法2010年6月至2012年9月河北省4家三级综合医院：河北省涿州市医院、河北大学附属医院（原河北省人民医院）、河北省邯郸市中心医院、河北省保定市第二中心医院，对570例直肠癌低位吻合患者，按吻合口到肛缘的距离分3组A组：＜2.0 cm(切除全部内括约肌)，B组：2.0～4.0 cm（相当于齿状线平面，切除部分内括约肌），C组：＞4.0 cm(保留全部内括约肌)。分别在术后3个月及1年以徐忠法五项十分评价标准及大便失禁生活质量问卷（the fecal incontinence quality of life questionnaire，FIQL）综合分析判断。结果在术后3个月，吻合口位置越低肛门功能评分越低（2.79 vs.4.94 vs.8.82，P＜0.05），经过1年的适应及功能锻炼后，各组的肛门功能评分稍有升高，A组评分仍然要低于B、C两组（5.38 vs.7.55,9.12， P＜0.05）。对自身生活质量满意方面，在术后1年A组患者的生活方式、心理应付/行为、抑郁/自我感受及窘迫尴尬方面均劣于 B、C（P＜0.05）两组。结论对于直肠癌的低位前切除术，吻合口位置越低肛门功能和生活质量就越差，对于吻合口距离肛缘＜2 cm者，术后肛门功能、生活质量明显下降。故在肿瘤学安全的基础上，吻合口距肛缘距离＞2.0 cm视实际情况保肛，而非为单纯保留肛门，追求保肛率，无视患者术后生活质量严重下降而强行保肛。
목적：통과분석문합구수평대항문배편공능화생활질량적영향，탐토직장암초저위문합보항겁한。방법2010년6월지2012년9월하북성4가삼급종합의원：하북성탁주시의원、하북대학부속의원（원하북성인민의원）、하북성함단시중심의원、하북성보정시제이중심의원，대570례직장암저위문합환자，안문합구도항연적거리분3조A조：＜2.0 cm(절제전부내괄약기)，B조：2.0～4.0 cm（상당우치상선평면，절제부분내괄약기），C조：＞4.0 cm(보류전부내괄약기)。분별재술후3개월급1년이서충법오항십분평개표준급대편실금생활질량문권（the fecal incontinence quality of life questionnaire，FIQL）종합분석판단。결과재술후3개월，문합구위치월저항문공능평분월저（2.79 vs.4.94 vs.8.82，P＜0.05），경과1년적괄응급공능단련후，각조적항문공능평분초유승고，A조평분잉연요저우B、C량조（5.38 vs.7.55,9.12， P＜0.05）。대자신생활질량만의방면，재술후1년A조환자적생활방식、심리응부/행위、억욱/자아감수급군박감개방면균렬우 B、C（P＜0.05）량조。결론대우직장암적저위전절제술，문합구위치월저항문공능화생활질량취월차，대우문합구거리항연＜2 cm자，술후항문공능、생활질량명현하강。고재종류학안전적기출상，문합구거항연거리＞2.0 cm시실제정황보항，이비위단순보류항문，추구보항솔，무시환자술후생활질량엄중하강이강행보항。
Objective To analyze the impact of anastomotic position on anal defecating function and life quality in patients with rectal cancer, and investigate the anus-preservation limitation of low anastomosis. Methods 570 cases of rectal cancer patients with low anastomosis in 4 hospitals in Hebei province, China from June 2010 to September 2012 were enrolled in this study. According to the distance between anastomotic stoma and anal verge, patients were divided into group A (<2.0 cm;all internal sphincter was resected), group B (2.0-4.0 cm, equivalent to the dentate line plane;partial internal sphincter was resected), and group C (>4.0 cm;all internal sphincter was retained). At the postoperative third month and first year, the comprehensive analysis and judgment of anal defecating function and life quality were conducted according to Xuzhongfa 5-items-10-points evaluation criteria and fecal incontinence quality of life questionnaire. Results At the third postoperative month, it was found that the anal function score was decreased with the lowering of anastomotic location (group A, 2.79 points;group B, 4.94 points; group C, 8.82 points), with significant differences among three groups (P<0.05). After 1 year of adaptation and functional exercise, the anal function score in each group rose slightly (5.38, 7.55 and 9.12 points in group A, B and C, respectively), and the differences among three groups were still significant (P<0.05). As for the satisfaction of life quality, the life mode, psychological coping/behavior, depression/self-feelings and miserable embarrassment in group A were significantly inferior to those in group B and C in the first postoperative year (P<0.05). Conclusions For rectal cancer patients with distance between anastomotic stoma and anal verge<2 cm, after low anterior resection, the postoperative anal defecating function and life quality are decreased significantly. Therefore, the forcible anus-preservation should not be performed.