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頁籤選單縮合
題名 | Does Anastomotic Method Affect Functional Outcome of Low Anterior Resection for Rectal Carcinoma?=腸吻合方法是否會影響直腸癌前下位切除術後之肛門直腸功能? |
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作者姓名(中文) | 姜正愷; 林楨國; | 書刊名 | 中華醫學雜誌 |
卷期 | 60:5 1997.11[民86.11] |
頁次 | 頁252-258 |
分類號 | 416.245 |
關鍵詞 | 前下位切除術; 肛門休止壓力; 直腸肛門抑制反射; Low anterior resection; Resting anal pressure; Rectoanal inhibitory reflex; |
語文 | 英文(English) |
中文摘要 | 背景:直腸癌行肛門保留手術後常會造成肛門直腸功能不良,在臨床上的表現有大便次數增加及各種程度的的肛門失禁。造成這些現象的原因一般相信除了『新直腸』容積變小外,還有術中肛門內括約肌及股盆腔神經的傷害。本篇文章的目的就是想探討直腸癌前下位切除手術後肛門直腸功能的改變及其機轉。 方法:本研究共包括三十一位病人,其中十八位接受直腸前下位切除術;依腸道理建吻合方式之不同分成手縫合(10人)及用EEA縫合(8人)兩組。另外十三人他們接受腹部大腸切除手術,是為對照組。所有病人在術前、術後一週及六個月接受肛門直腸壓力測驗。另外在術前及術後六個月追蹤時做臨床肛門直腸功能調查。 結果:術後一週肛門休止壓力在手縫合及EEA縫合兩組均有意義的下降(手縫:69.4± 14.8 mmHg,median:71.5 mmHg vs. 43.7±16.2 mmHg,median:48.5 mmHg,95% C.I of mean difference:6.4~24.6 mmHg;EEA:51.3±14.6 mmHg,median:48.0 mmHg vs. 38.8±16.6 mmHg,median:41.5 mmHg,95% C.I. of mean difference:5.6~49.8 mmHg),而在手縫合組術後六個月有部分回升現象。肛門收縮壓及肛門功能長度在術前、術後均沒有明顯變化。直腸肛門抑制反射在術前百分之九十病人都,而在術後六個月追蹤時,手縫組有百分之七十,EEA組只有百分之三十八的病人有此反射。在臨床上術後兩組大便次數均有增加的趨向,也有苦幹程度的失禁。在手縫及EEA縫合二組中,大便次數的增加並無差別,而在EEA組其肛門失禁程度比手縫組大。 結論:直腸癌行前下次位切除後肛門直腸功能會變差,而手縫合似乎經EEA縫合有較好的功能恢復。 |
英文摘要 | Background: Anorectal dysfunction may occur following sphincter-saving resection for rectal carcinoma. The dysfunction may present clinically with increased stool frequency and varying degrees of fecal incontinence. It is postulated that these presentations come about from reduced neorectal capacity, as well as internal anal sphincter injury, during transanal instrumentation or through damage to the nerve supply in the course of rectal dissection. The purpose of this study was to assess the functional results of low anterior resection (LAR), and the relative importance of each mechanism. Methods: Thirty-one patients were included in this study, eighteen of whom had standard LAR for rectal carcinoma. Bowel continuity was reestablished by handsewn (HS) 2-layer suture in 10 patients and stapled EEA (U.S.Surgical Corporation) anastomosis in the other 8 patients. Thirteen patients who had received abdominal surgery other than LAR were the control group. Anorectal manometry was performed preoperatively and one week, the six months post-operatively, Clinical assessment was done pre-operatively and six months post-operatively. Results: Resting anal pressure was significantly reduced in both HS and EEA groups post-operatively (HS: 69.4 ± 14.8 mmHg, median:71.5 mmHg vs. 43.7 ± 16.2 mmHg, median: 48.5 mmHg, 95% confidence interval of mean difference: 6.4~24.6 mmHg; EEA: 51.3 ± 14.6 mmHg, median: 48.0 mmHg vs. 38.8 ± 16.6 mmHg, median: 41.5 mmHg, 95% confidence interval of mean difference: 5.6~49.8 mmHg), partial recovery was noted in the HS group six months later. The squeeze pressure and functional length of the anal canal showed no difference pre- and post-operatively. Rectoanal inhibitory reflex was present in 90% of the patients preoperatively, but in on only 70% of the HS, and 38% of the EEA group, six months post-operatively. Clinically, increased bowel frequency and varying degrees of incontinence were experienced postoperatively. There was no difference in bowel frequency between the two groups, but worse continence grade was seen in the EEA group. Conclusions: LAR for rectal carcinoma resulted in impaired anorectal function. Handsewn anastomosis seemed to have a better functional outcome than EEA stapled anastomosis. |
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