surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2021-11-3-195-202surgonco-600Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESРеконструкция прямой кишки после тотальной мезоректумэктомии: функциональные результаты и качество жизниRectal Reconstruction after Total Mesorectumectomy: Functional Outcomes and Quality of Lifehttps://orcid.org/0000-0002-5565-615XРасуловА. О.RasulovA. O.

Расулов Арслан Османович – д.м.н., профессор, отдел малоинвазивной тазовой хирургии, кафедра эндоскопической хирургии факультета дополнительного профессионального образования

Москва

Arslan O. Rasulov – Dr. Sci. (Med.), Prof., Department of Minimally Invasive Pelvic Surgery, Department of Endoscopic Surgery for Advanced Professional Education

Moscow

https://orcid.org/0000-0003-0641-0572БайчоровА. Б.BaychorovA. B.

Байчоров Аслан Борисович – к.м.н., отделение колопроктологии

Москва

Aslan B. Baychorov – Cand. Sci. (Med.), Department of Coloproctology

Moscow

a.baychorov@mknc.ruhttps://orcid.org/0000-0003-0679-9178МерзляковаА. М.MerzlyakovaA. M.

Мерзлякова Анна Михайловна – к.м.н., отделение реабилитации

Москва

Anna M. Merzlyakova – Cand. Sci. (Med.), Rehabilitation Department

Moscow

ОвчинниковаА. И.OvchinnikovaA. I.

Овчинникова Анна Ивановна – тделение проктологии Научно-консультативного отделения

Москва

Anna I. Ovchinnikova – Department of Proctology, Scientific Advisory Office

Moscow

https://orcid.org/0000-0001-8783-8874СемьянихинаА. В.SemyanikhinaA. V.

Семьянихина Александра Владимировна – лаборатория иммунологии гемопоэза

Москва

Aleksandra V. Semyanikhina – Laboratory of Haematopoiesis Immunology

Moscow

НИИ урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал Национального медицинского исследовательского центра радиологии; Московский государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияN.А. Lopatkin Scientifc Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Radiological Centre for Radiology; A.I. Yevdokimov Moscow State University of Medicine and DentistryRussian FederationМосковский клинический научный центр имени А.С. ЛогиноваРоссияA.S. Loginov Moscow Clinical Scientific CentreRussian FederationНациональный медицинский исследовательский центр онкологии им Н.Н. БлохинаРоссияN.N. Blokhin National Medical Research Centre of OncologyRussian Federation202101102021113195202Copyright © Расулов А.О., Байчоров А.Б., Мерзлякова А.М., Овчинникова А.И., Семьянихина А.В., 20212021Расулов А.О., Байчоров А.Б., Мерзлякова А.М., Овчинникова А.И., Семьянихина А.В.Rasulov A.O., Baychorov A.B., Merzlyakova A.M., Ovchinnikova A.I., Semyanikhina A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/600Введение

Введение. Целью исследования является сравнение функциональных результатов и качества жизни больных, перенесших различные методики реконструкции прямой кишки после низкой передней резекции по поводу рака.

Материалы и методы

Материалы и методы. В проспективное рандомизированное контролируемое исследование включено 90 пациентов, перенесших тотальную мезоректумэктомию с формированием J-образного резервуара (J-ОР), анастомоза «бок-в-конец» (БВК) или анастомоза «конец-в-конец» (КВК).

Результаты и обсуждение

Результаты и обсуждение. Проанализировано 22 пациента с J-ОР, 30 — с БВК и 38 — с КВК. По техническим причинам 26,6 % J-ОР конвертированы в другие анастомозы. Порог неоректальной чувствительности, первый и постоянный позыв к дефекации, а также максимально переносимый объем были выше при J-ОР в 3–6–12 мес. после операции.Выраженные проявления СНПР в сроки 6 мес. после операции достоверно чаще присутствовали в группе КВК в сравнении с J-ОР и БВК (21, 0 и 3,3 % соответственно, p < 0,05). Частота стула при J-ОР была достоверно ниже в сравнении с БВК и КВК в 3–6–12 мес. Показатели баллов Wexner score соответствовали 3, 5, 6 в сроки 6 мес. (p < 0,05) и 0, 1, 1 в 12 мес. при J-ОР, БВК и КВК соответственно (p > 0,05). Эвакуаторная дисфункция присутствовала в сроки 6 мес. у 59,1 % с J-ОР, 33,3 % с БВК и 21,1 % с КВК.Качество жизни (FIQL) при J-ОР и БВК достоверно лучше в сравнении с анастомозом КВК в шкалах «образ жизни» (3,21, 3,22 и 3,03 соответственно, p < 0,05) и «копинг» (3,29, 3,21 и 2,95 соответственно, p < 0,05) до 12 месяцев после операции.

Заключение

Заключение. Формирование J-образного резервуара после низкой передней резекции приводит к улучшению анальной континенции в сроки 3–6 месяцев после операции, уменьшению проявлений синдрома низкой передней резекции и повышению качества жизни (FIQL). Техническая простота исполнения анастомоза «бок-в-конец» и отсутствие проблемы эвакуаторной дисфункции позволяют также рекомендовать его к применению, учитывая очевидные преимущества перед анастомозом «конец-в-конец».

Background

Background. The study aims to compare the functional outcomes and quality of life in patients having variant rectal reconstruction procedures after low anterior resection for cancer.

Materials and methods

Materials and methods. A prospective randomised controlled trial enrolled 90 patients who underwent total mesorectumectomy with formation of J-pouch (J-P), side-to-end (STE) or end-to-end (ETE) anastomoses.

Results and discussion

Results and discussion. We analysed 22 J-P, 30 STE and 38 ETE patients. For technical reasons, 26.6 % J-Ps were remodelled to other anastomoses. The neorectal sensory threshold, first and permanent defecation urges and maximal tolerated volume were higher in J-P at months 3–6–12 postoperatively.Severe low anterior resection syndrome events at post-surgery month 6 were significantly more frequent in the ETE vs. J-P and STE cohorts (21, 0 and 3.3 %, respectively, p < 0.05). Stool frequency was significantly lower in J-P vs. STE and ETE at months 3–6–12. Wexner score was 3, 5, 6 at month 6 (p < 0.05) and 0, 1, 1 at month 12 for J-P, STE and ETE, respectively (p > 0.05). Evacuatory dysfunction was present at month 6 in 59.1 J-P, 33.3 STE and 21.1 % ETE.Quality of life (FIQL) in J-P and STE was significantly higher vs. ETE anastomoses in the Lifestyle (3.21, 3.22 and 3.03, respectively, p < 0.05) and Coping (3.29, 3.21 and 2.95, respectively, p < 0.05) scales to month 12 postoperatively.

Conclusion

Conclusion. The J-pouch formation after low anterior resection ameliorates anal continence at months 3–6 post-surgery, reduces low anterior resection syndrome and improves quality of life (FIQL). The ease of implementation and irrelevance of evacuatory dysfunction in side-to-end anastomosis make it a superior choice over end-to-end surgery.

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The authors declare that there are no conflicts of interest present.