CAJ | 학술논문

目的：探讨评价低位直肠癌腹腔镜下腹会阴联合切除（APR）术后原位人工肛门重建的临床应用。方法回顾性分析2010年1月至2013年1月，南京大学医学院附属鼓楼医院普通外科收治的行APR手术的60例低位直肠癌患者的临床资料。根据术后肛门重建方式的不同，分为造口组（32例，行结肠腹壁造口）和人工肛门组（28例，予原位人工肛门重建）。术后1年对两组患者采用排粪失禁生活质量评分（FIQL scale）和克利夫兰排粪失禁评分（CCS-FIS scale）进行评价。同时比较两组患者临床结局及术后并发症情况。结果与造口组比较，人工肛门组的手术时间较长[（204．8±18．8）分比（173．3±23．5）分， P＜0．01]，首次排气时间较晚[（45．1±9．3） h比（27．7±9．4） h， P＜0．01）]，术后造口水肿的发生率较高（42．9％比18．8％，P＜0．05）；但两组间平均住院时间、切口感染及尿潴留等并发症的差异无统计学意义（均P＞0．05）。术后1年排粪失禁生活质量评分显示，人工肛门组的社会心理评分明显优于造口组（3．1比2．2， P＜0．01），而行为评分、生活评分和自我认知评分的差异无统计学意义（P＞0．05）。术后1年人工肛门组20例（71.4%）患者排粪控制满意。结论低位直肠癌腹腔镜下APR术后进行原位人工肛门重建，可保留患者肛门功能，提高生活质量。
목적：탐토평개저위직장암복강경하복회음연합절제（APR）술후원위인공항문중건적림상응용。방법회고성분석2010년1월지2013년1월，남경대학의학원부속고루의원보통외과수치적행APR수술적60례저위직장암환자적림상자료。근거술후항문중건방식적불동，분위조구조（32례，행결장복벽조구）화인공항문조（28례，여원위인공항문중건）。술후1년대량조환자채용배분실금생활질량평분（FIQL scale）화극리부란배분실금평분（CCS-FIS scale）진행평개。동시비교량조환자림상결국급술후병발증정황。결과여조구조비교，인공항문조적수술시간교장[（204．8±18．8）분비（173．3±23．5）분， P＜0．01]，수차배기시간교만[（45．1±9．3） h비（27．7±9．4） h， P＜0．01）]，술후조구수종적발생솔교고（42．9％비18．8％，P＜0．05）；단량조간평균주원시간、절구감염급뇨저류등병발증적차이무통계학의의（균P＞0．05）。술후1년배분실금생활질량평분현시，인공항문조적사회심리평분명현우우조구조（3．1비2．2， P＜0．01），이행위평분、생활평분화자아인지평분적차이무통계학의의（P＞0．05）。술후1년인공항문조20례（71.4%）환자배분공제만의。결론저위직장암복강경하APR술후진행원위인공항문중건，가보류환자항문공능，제고생활질량。
Objective To assess the outcome and quality of life artificial anal reconstruction after laparoscopic abdominoperineal resection(APR) in low rectal cancer patients. Methods Clinical data of 60 cases with low rectal cancer undergoing APR in our department from January 2010 to January 2013 were retrospectively analyzed. Sixty patients were divided into 2 groups according to anal reconstruction procedure, inclding 32 patients of abdominal colostomy as colostomy group and 28 patients of in-situ artificial anal reconstruction as anal reconstruction group. After a median follow-up of 1 year, the quality of life was assessed by Fetal Incontinence Quality of Life Scale (FIQL scale) and Cleveland Clinic Florida Fecal Incontinence Scores (CCS-FIS scale). In addition, the outcome and complications were compared between the two groups. Results Compared with the colostomy group, the anal reconstruction group presented longer operation time[(204.8±18.8) min vs. (173.3±23.5) min, P<0.01], later passage time [(45.1 ±9.3) h vs. (27.7 ±9.4) h, P<0.01], and higher incidence of mucosal edema (42.9% vs. 18.8%, P<0.05). There were no significant differences in average hospital stay and other complication morbidities (all P>0.05). After follow-up, the embarrassment scale in anal reconstruction group was better compared to colostomy group (3.1 vs. 2.2, P<0.01). However, there were no significant differences in the lifestyle, coping and depression scales between the two groups (allP>0.05). Twenty (71.4%) patients in anal reconstruction group had satisfactory continence 1 year after operation. Conclusion In-situ artificial anal reconstruction after laparoscopic abdominoperineal resection can preserve fecal function in low rectal cancer patients and improve the quality of life after APR operation.