摘要目的：探讨评价低位直肠癌腹腔镜下腹会阴联合切除（APR）术后原位人工肛门重建的临床应用。方法回顾性分析2010年1月至2013年1月，南京大学医学院附属鼓楼医院普通外科收治的行APR手术的60例低位直肠癌患者的临床资料。根据术后肛门重建方式的不同，分为造口组（32例，行结肠腹壁造口）和人工肛门组（28例，予原位人工肛门重建）。术后1年对两组患者采用排粪失禁生活质量评分（FIQL scale）和克利夫兰排粪失禁评分（CCS-FIS scale）进行评价。同时比较两组患者临床结局及术后并发症情况。结果与造口组比较，人工肛门组的手术时间较长[（204．8±18．8）分比（173．3±23．5）分， P＜0．01]，首次排气时间较晚[（45．1±9．3） h比（27．7±9．4） h， P＜0．01）]，术后造口水肿的发生率较高（42．9％比18．8％，P＜0．05）；但两组间平均住院时间、切口感染及尿潴留等并发症的差异无统计学意义（均P＞0．05）。术后1年排粪失禁生活质量评分显示，人工肛门组的社会心理评分明显优于造口组（3．1比2．2， P＜0．01），而行为评分、生活评分和自我认知评分的差异无统计学意义（P＞0．05）。术后1年人工肛门组20例（71.4%）患者排粪控制满意。结论低位直肠癌腹腔镜下APR术后进行原位人工肛门重建，可保留患者肛门功能，提高生活质量。

abstractsObjective To assess the outcome and quality of life artificial anal reconstruction after laparoscopic abdominoperineal resection(APR) in low rectal cancer patients. Methods Clinical data of 60 cases with low rectal cancer undergoing APR in our department from January 2010 to January 2013 were retrospectively analyzed. Sixty patients were divided into 2 groups according to anal reconstruction procedure, inclding 32 patients of abdominal colostomy as colostomy group and 28 patients of in-situ artificial anal reconstruction as anal reconstruction group. After a median follow-up of 1 year, the quality of life was assessed by Fetal Incontinence Quality of Life Scale (FIQL scale) and Cleveland Clinic Florida Fecal Incontinence Scores (CCS-FIS scale). In addition, the outcome and complications were compared between the two groups. Results Compared with the colostomy group, the anal reconstruction group presented longer operation time[(204.8±18.8) min vs. (173.3±23.5) min, P<0.01], later passage time [(45.1 ±9.3) h vs. (27.7 ±9.4) h, P<0.01], and higher incidence of mucosal edema (42.9% vs. 18.8%, P<0.05). There were no significant differences in average hospital stay and other complication morbidities (all P>0.05). After follow-up, the embarrassment scale in anal reconstruction group was better compared to colostomy group (3.1 vs. 2.2, P<0.01). However, there were no significant differences in the lifestyle, coping and depression scales between the two groups (allP>0.05). Twenty (71.4%) patients in anal reconstruction group had satisfactory continence 1 year after operation. Conclusion In-situ artificial anal reconstruction after laparoscopic abdominoperineal resection can preserve fecal function in low rectal cancer patients and improve the quality of life after APR operation.