Estudo comparativo do esvaziamento intestinal por meio de cintilografia entre pacientes portadores de anastomoses coloanais com e sem reservatorio

AUTOR(ES)
DATA DE PUBLICAÇÃO

2002

RESUMO

Bowel transit reconstruction by straight coloanal anastomosis has been largely used in order to preserve the defecation function after rectal malignancy excision, and in the treatment of benign diseases as well. However, preserving the sphincter function makes many patients complain of urgency to defecate, fragmented evacuation and some degree of incontinence, mainly during the first two postoperative years. After the introduction of the colonic pouch, these alterations seem to bee less frequent, as it increases the reservoir capacity. However, many patients have post-surgical constipation. Consequently, these sphincter-saving techniques still require studies, as better results must be achieved. Scintigraphy is a quantitative method, not so influenced by patient position. As a result, it suitably gives the residual amount of feces after defecation. However, there are few papers with reference to its use, and there is not a clear standardization of the method. The aim of this study was to define the best way for its utilization in order to assess intestinal emptying in patients submitted to coloanal anastomosis, with or without a pouch, and its correlation with functional index. Patients who had undergone rectocolectomy, with bowel transit reconstruction by coloanal handsewn anastomosis, performed at the level of the dentate line, straight or with a colonic J pouch, were studied. There were 12 patients with straight coloanal anastomosis and 15 with reservoir anastomosis. Artificial feces, made of psyllium, water and 3 mCi of microcoloid-99mTc, were introduced into the distal portion of the anastomosed colon, until the patient felt the desire to defecate. Static images were then obtained, with a ?full? colon/reservoir, and after defecation, with an ?empty? colon/reservoir. Regions of interest were designed around the ?full? colon, and then transposed to the ?empty? colon figure. The amount of emptying was in this way determined. Patients responded to a questioning, considering diurnal and nocturnal incontinence (minor and major), use of pads, fecal urgency, flatus control, spontaneous evacuation, fragmentation, and number of evacuations/24 hours. For statistical analysis, the Mann-Whitney test was used. To calculate correlation, the Spearman rank analysis was performed. For all of them were considered significant values of p<0.05. Emptying was better in the reservoir group (group I, 51 +/- 29.22%; group II, 84.42 +/- 14.67%; p<0.05). Except for spontaneous evacuation, all the functional parameters were better for group II. Spontaneous evacuation was not different between the groups. Age and post-surgical period did not influence these results, as they did not show significant differences. Correlations analysis failed to demonstrate clear relationship among emptying, functional outcome, and size of the reservoir. This happened probably because of the multiple factors involved in evacuation and continence. In spite of it, reservoir coloanal anastomosis could be performed after total rectal resection in a sphincter-saving procedure, as it improved the quality of life of these patients, not impairing surgical morbid-mortality

ASSUNTO(S)

reto - tumores exploração por radioisotopos

ACESSO AO ARTIGO

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