CAJ | 학술논문

目的分析完全腹腔镜下超低位直肠癌保肛术对直肠肛管功能的影响.方法应用超声刀在腹腔镜下对43例超低位直肠癌患者实施全直肠系膜切除原则的根治性手术,肛门部用二联式手工吻合法完成结直肠/肛管吻合.术前测试其直肠内液体存留时间、直肠静息压(RRP)、肛管静息压(ARP)和肛管最大收缩压(AMCP),术后1、3、6个月测试其每日排便次数;3、6个月测试其直肠内液体存留时间、RRP、ARP和AMCP等.结果 43例患者手术经过均顺利,中转开腹4例,无严重副损伤,随访6 ～ 36个月,平均20个月,3个月后直肠内液体存留时间、排便感觉功能、肛门控便功能、RRP、ARP与术前比较差异有统计学意义(P＜0.05);6个月后直肠内液体存留时间、排便感觉功能、肛门控便功能、RRP、ARP、AMCP与术前比较差异无统计学意义(P＞0.05).结论超低位直肠癌行腹腔镜下超低位切除、肛门部二联式手工吻合保肛术有安全、经济、创伤小、疗效可靠、住院时间短等优点,值得推广应用.
목적 분석완전복강경하초저위직장암보항술대직장항관공능적영향.방법 응용초성도재복강경하대43례초저위직장암환자실시전직장계막절제원칙적근치성수술,항문부용이련식수공문합법완성결직장/항관문합.술전측시기직장내액체존류시간、직장정식압(RRP)、항관정식압(ARP)화항관최대수축압(AMCP),술후1、3、6개월측시기매일배편차수;3、6개월측시기직장내액체존류시간、RRP、ARP화AMCP등.결과 43례환자수술경과균순리,중전개복4례,무엄중부손상,수방6 ～ 36개월,평균20개월,3개월후직장내액체존류시간、배편감각공능、항문공편공능、RRP、ARP여술전비교차이유통계학의의(P＜0.05);6개월후직장내액체존류시간、배편감각공능、항문공편공능、RRP、ARP、AMCP여술전비교차이무통계학의의(P＞0.05).결론 초저위직장암행복강경하초저위절제、항문부이련식수공문합보항술유안전、경제、창상소、료효가고、주원시간단등우점,치득추엄응용.
Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.