Correlação entre parametros fisiologicos e função clinica nas anastomoses coloanais com e sem reservatorio

AUTOR(ES)
DATA DE PUBLICAÇÃO

1997

RESUMO

Sphincter-saving procedures for the treatment of carcinoma of the rectum have represented important progress in the maintenance of patient s life quality following complete proctectomy without significantly compromising its prognosis. The purpose of this study is to compare manual coloanal anastomosis with and without colonic pouch and evaluate functional results as well as analysis ofthe physiologic parameters. The hypothesis for this study are: 1) colonic pouch anal anastomosis would present better functional results than straight coloanal anastomosis, 2) physiologic parameter measurements would be important to the prediction of functional results. Forty-two patients were undergone to surgery by the Coloproctology Unit, Discipline of the Diseases of th~ Digestive System, School of Medical Sciences, State University of Campinas from 1979 to 1995. Twenty-six patients were female with ages ranging from 28 to 80 (mean age, 55.6:i:13.9) years. Indications for surgery were the following: adenocarcinoma of the rectum (40 patients), rectal villous adenoma (1 patient) and rectal hemangioma (1 patient). Surgeries performed were: primary manual coloanal anastomosis with fecal diversion (5 patients - 11.9%), delayed coloanal anastomosis (12 patients - 28.5%), and manual colonic pouch anastomosis (25 patients - 59.6%). Patient;s with stoma closure or following colic stump ressection within a six-month period with no post-surgical radiotherapy and absence of pelvic or abdominal disease at the time of the evaluation were included in the study. Patients considered as Group 1 ~ere submitted to straight coloanal anastomosis, and Group 2 patients with colonic pouch-anal anastomosis. Clinical data analysed were: mean frequency of daily and noctumal evacuations, and occurrence of fragmented evacuations. Patients responded to a questionary on sphincterian function (functional index) for posterior quantification of this function. Physiological parameters studied were: m-ean resting pressure, maximum squeeze pressure, search of anoneorectal inhibitory reflex, mean resting pressure in the highest resting pressure zone, asimmetry index in the highest resting pressure zone, leveI of the highest pressure zone in relation to the length of the anal canal, corresponding volume to the first anoneorectal sensation, the need to evacuate and maximum neorectal capacity besides neorectal compliance measurement. For statistical analysis, non-parametric unpaired, bi-caudal test (Mann-Whitney) was used, considering significant values of p<0.05 to compare day and night evacuation frequency measurements with the mean values of the functional index and physiological parameters among both groups. For the analysis of occurrence of non-fragmented evacuations and anoneorectal reflex, contingence table and the significance value determined by the Fischer test. To calculate correlation between functional index and physiological parameters, correlation coefficient was used and values ofp<0.05 were considered statistically significant. Group 1 patients presented a mean frequency of daily evacuations higher than Group 2 (3.6j:1.9 and 2.7 j:1.9; p<0.05). The number ofnocturnal evacuations was similar between groups (0.9j:1.3 and 0.6j:1.9 respectively, ns). Fragmented evacuations occurred more frequently among Group 1 patients (64% and 20%, p<0.05) and the occurrence ofthe inhibitory anoneorectal reflex was more frequent in Group 1 patients (23.5% and 12.0%; p<0.05). The analysis ofthe functional index showed better results among Group 2 patients (48.9j:8.5 and 42.2j:8.8; p<0.05) and the occurrence of the anoneorectal inhibitory reflex was more frequent in Group 1 patients (23.5% and 12.0%; p<0.05). Analysis of physiological parameters showed mean anal resting pressure in the highest pressure zone higher ~n Group 1 compared to Group 2 patients (38.3j:13.7 mmHg and 28.0j:10.1 mmHg; p<0.05). Mean air volume necessary to trigger the need to evacuate was significantly higher in Group 2 (139.8j:78.3ml and 68.8j:47.5ml; p<0.05). Neorectal compliance values were higher in Group 2 patients (10.9j:6.8ml/mmHg and 5.7j:3.6ml/mmHg; p<0.05). Other physiological parameters (mean resting anal pressure, maximum anal squeeze pressure, asimetry index and the leveI of the highest resting zone pressure, intraneorectal balloon inflation volume correspondent to the first anoneorectal sensation and maximum neorectal capacity did not present statistical difference among the two groups. Correlation between the physiological parameters and functional index showed statistical significance in the mean resting anal pressure, maximum anal squeeze pressure, mean anal pressure in the highest pressure zone and the leveI of the highest resting pressure zone among Group 2 patients. Straight coloanal anastomosis may be related to higher evacuation frequency and the occurrence of fragmented evacuations, while colonic p01!lch was related to better functional results in this study

ASSUNTO(S)

anus - cancer fisiologia cirurgia - tecnica

ACESSO AO ARTIGO

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