19例直肠癌腹会阴切除股薄肌移植肛门成形术

Gracilis Muscle Grafting Anoplasty after Abdomen-perimeal Resection of Recta——A report of 19 cases

目的:肛管、直肠癌扩大根治切除的同时,利用股薄肌肛门成形,以取得肛门节制力,避免了腹壁人工肛门。方法:肛管、直肠癌扩大根治切除,将结肠拉至会阴部并将已从右大腿游离好的股薄肌环绕一周并固定于右坐骨结节。肌肉、肠管间断缝合后肠管断端与会阴部皮肤间断缝合。结果:12例术后三个月肛门功能I级(排便如常人);3例功能为II级;2例III级;1例围手术期死亡。结论:肛管、直肠癌扩大根治切除(R3手术),手术彻底,不影响生存期。利用股薄肌移植,于原肛门处形成一有节制力的新肛门,尽管手术有相当的难度,但只要掌握住拉出肠管血循良好、环绕的股薄肌又不致过紧造成远端肠管坏死,而导致手术失败,则不仅保证了患者的生存期,又在原位形成一个有节制力的肛门,应是值得提倡、推广的手术。

Objective: All cases using gracilis muscle anoplasty after extended radical operation to attain anal comtinence and has been avoid abdomen wall anus. Method: After abdomen-perimeal resection new anus has mad with gracilis muscle surrounding the end of cutting colon. Result: Follow-up after 3 months postoperatively demonstrated that 12 cases with grade I anus function (continence as normal), 3 cases grade II (difficult to control watery-like stool), 2 cases grade III(difficult to control watery -like stool), 2 cases grade III(difficult to control congee-like stool). Only one of the patient died in perioperative period. Conclusion: Abdomen-perimeal resection is radical operation and no decrease the survival. 19 cases using gracilils muscle anoplasty the new anus is been made. Though this operation is very difficult, but the drawn out colon has been keep a good blood circulation in distal, the operation is successful . Authors recommend this operation since it ensures both through radical desection and retention of anus, with which most patiens would have satisfactory continence.