作者：吴恺明, 冯伟东, 张明亮

单位：中山大学附属第一医院 胃肠外科中心, 广东 广州 510080

Authors:  Wu Kaiming, Feng Weidong, Zhang Mingliang

Unit:  Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, Guangdong, China

摘要：

目的 明确服碳酸钙联合直肠壶腹和直肠瓣重建术对直肠癌前切除术后生活质量的改善效果。方法 收集2018年7月至2019年6月中山大学附属第一医院收治的腹腔镜直肠癌Dixon手术患者90例,随机分成对照组、碳酸钙组和钙+重建组。对照组和碳酸钙组患者接受单纯结肠-直肠(肛管)端端吻合术,钙+重建组接受行直肠壶腹和直肠瓣重建术+结肠与直肠(肛管)端端吻合术;碳酸钙组和钙+重建组在术后1周起,每天口服碳酸钙1200 mg。术后第3个月和第6个月,用EORTC QLQ-CR29量表评估患者生活质量,以及评估钙相关并发症。结果 术后3个月,钙+重建组患者"黏液便""大便失禁""频繁大便"和"社交困扰"的发生率,均低于对照组;碳酸钙组仅在"频繁大便"项目的评分优于对照组。术后6个月,钙+重建组患者焦虑、大便失禁、频繁大便和社交困扰的发生率,均低于对照组。碳酸钙组仅在"频繁大便"项目的评分优于对照组。两组均未见高钙血症和新发泌尿系结石。结论 口服碳酸钙联合直肠壶腹和直肠瓣重建术可改善直肠癌前切除患者术后生活质量,疗效比单纯口服碳酸钙更全面。

关键词：  碳酸钙; 直肠重建; 直肠癌; 生活质量

Abstract：

Objective To determine the improvement of oral calcium carbonate intake combined with rectal ampulla and rectal valve reconstruction to the quality of life after low anterior rectal resection. Methods Ninety patients undergoing laparoscopic rectal cancer surgery at the First Affiliated Hospital of Sun Yat-sen University from July 2018 to June 2019 were collected and randomly divided into the control group, calcium carbonate group, and calcium + reconstruction group. Patients in the control group and the calcium carbonate group received simple colon-rectal (anal canal) end-to-end anastomosis, and the calcium +reconstruction group received rectal ampulla and rectal valve reconstruction + colon-rectal (anal canal) end-to-end anastomosis; carbonate in the calcium group and the calcium + reconstitution group, 1200 mg of calcium carbonate was orally administered daily from 1 week after the operation. EORTC QLQ-CR29 was used to assess patients' quality of life and calcium-related complications at 3 and 6 months after surgery. Results At 3 months after surgery, the incidence of "mucus stool", "fecal incontinence", "frequent stool", and "social disturbance" in the calcium + reconstruction group were lower than those in the control group; the calcium carbonate group was only in the "frequent stool" Score better than the control group. At 6 months after surgery, the incidence of "anxiety", "fecal incontinence", "frequent stool", and "social distress" in the calcium + reconstruction group were lower than those in the control group. The calcium carbonate group scored better in the "frequent stool" item than the control group only. No hypercalcemia or new urinary stones were detected in either group. Conclusion Oral calcium carbonate intake combined with rectal ampulla and rectal valve reconstruction can improve the quality of life of patients with rectal low anterior resection, and the effect is more comprehensive than that of oral calcium carbonate intake alone.

Key Words:  Calcium carbonate; Reconstruction of rectum; Rectal cancer; Quality of life