四联术式原位肛门整形重建改进的研究

Study on improving four-step associated operation of anus rebuild in situs

目的:探讨低位直肠癌患者行iMles术同时,I期行原位肛门重建的四联术式的方法、效果、意义,以及四联术的改进之处。方法:90例低位直肠癌行iMles术后,按不同手术方式分为两组行原位肛门重建:①四联术式组:70例,按四项联合术进行原位肛门重建,其中38例重建法作了改进;②单纯术组:20例,单行I期肛门外括约肌重建术重建原位肛门;③另以32例正常健康人,作为肛门功能研究测定的对照组。结果:①四联术式组术后排便功能及肛门内液体存留时间优于单纯组;②四联术式组中采用改进重建38例,排便功能显著优于未改进者。结论:低位直肠癌iMles术后I期原位肛门重建宜采用改进的四联术式,才能建立肛门基本的正常解剖结构和生理功能。

Objective While study in the use of Miles＇ operation for low rectal cancer patients, discussing the method, result and significance of Ⅰ stage four-step associated operation of reconstructed anus in original situation and its improved method and result. Methods After the 90 cases of low rectal cancer were operated on Miles＇ operation, two groups are separated to do reconstructed anus in original situation which are depended on the following different operation methods.①The group of four-step associated operation： 70 cases were done reconstructed anus in original situation with 4 steps associated operation. The reconstructed method of 38 cases was modified. ②The group of pure operation： 20 cases were done reconstructed anus in original situation with the reconstructed operation method ofⅠ stage external sphincter ani. ③32 cases of normal persons are considered as comparison group to survey the anus function. Results ① Compared the defecation function and the liquid kept in the anus, the group of four-step associated operation is better than the group of pure operation＇ s. ②The group of four-step associated operation adopts the modified reconstructed method, so the defecation function of 38 cases is better than the without modified method obviously. Conclusion It shows that it is wise to adopt the improved four-step associated operation to do Ⅰ stage reconstructed anus in original situation after the Miles＇ operation of low rectal cancer. Then anus can be built the normal anatomic framework and physiological function.