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)五項十分制評價標準,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. 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.