Influence Of The Level Of Anastomosis To Functional Outcome After Anterior Rectal Resection For Rectal Carcinoma

The object of the investigation is to study the influence of the level of anastomosis on the anorectal functional outcome after anterior rectal resection for rectal carcinoma. Fifty-five patients scheduled for anterior resection with low rectal anastomosis due to rectal carcinoma were studied before and after operation. Patients were divided into two groups according to the level of the anastomosis: the distance between anastomosis and anal verge of group A (n=27) is less than 6cm, that of B group is more than 6cm(n=28). The anorectal manometry was performed using a high-pressure ,low compliance system(PolyGramTM).The follow parameters were evaluated in before and after operation, including anal resting pressure(RP),maximal squeeze pressure(MSP),rectal compliance(RC),high pressure zone(HPZ),rectal volume,rectoanal inhibitory reflex. Functional outcome was assessed clinically using the incontinentce score. All datas were analysised by means of statistics including the fourfold table chi-square test ,the matched-pairs signed rank test and Fishers exact test. Result: RP decreased after opration (P<0.05), which continued until three months had passed. It is more remarkable in A group, but after postoperatively three months, there were no differ from before operation. RC,UV,FP and MTV after operatively three month were distinct from before operation, but they made progresses with time going by. So they are similar to each other after six months after operation of low anterior resection. In the field of RP,MSP,HPZ ,two groups were similar not only in preoperation but in postoperation ,it is not statistical meanings. After operatively one month, RP was different from it before operation, but after three months, there were no differ. Rectal volume of after operation was decreased, which was more remarkable in the short group. In contrast with two groups, it was found out that RAIR was abolished in almost all patients. In majority of patients, regardless of the group, this reflex remained absent throughout the half year. However, there was different from A group to B group. In group A, which shared really no recovery for half year; in group B, it persisted after operation in half the cases, and the reflex returned in a few cases with six months. There were also different in UV and MTV. After three months of operation, most values of rectal capacity tended to be smaller in the short group. Postoperatively, stool frequency increased and urgency to defecate occurred, which continued until there months. Incontinent score increased, which was more remarkable in group A.