原位肛门整形重建术的研究

Studying on the anus plastic and reconstruction in the original situatio

目的:探讨改进的内外括约肌在原位肛门整形重建术中的应用及其手术效果。方法:改进包括:①肛门内括约肌改进为双层双环肌套;②肛门外括约肌改进为股薄肌采用"围巾式"环绕结肠末端一周,其远端剖为两条,一条缝合固定于耻骨韧带;另一条缝合固定于骶尾韧带,即为肛门外括约肌重建和外括约肌浅部和深部的重建。结果:38例术后肛门外形及功能和远期生活质量、生存率均更为满意。术后随访总优良率达94.73%;远期生存率达76.32%。结论:低位直肠癌Miles术后,同时行改进的内外括约肌原位肛门整形重建的效果是可行的,更接近正常的肛门解剖结构和生理功能。

Objective Studying on the method and the effect of the improved treatment of reconstructing the anus in the original situation with the internal and external sphincters. Methods The improvements include： （1）The internal sphincter is improved on two-layer and two-ring; （2）about the external sphincter： gracilis is made a circle around on the end of the colon, which the far end is cut to two strips. One is fastened on the pubis ligament, another is fastened on the sacrum ligament. These mean the anus external sphincter is reconstructed and the external sphincter is improved on lower and deeper positions＇ reconstruction. Results Both the shapes and the functions of the anuses and the existent rate of 38 cases are satisfied. The excellent rate has reached 94.73%, and the existent rate in the long term has reached 76.32%. Conclusion All the above shows that the method is efficient, which is the operation by the improved treatment of reconstructing the anus in the original situation with the internal and external sphincters after the Miles. The reason is that using this method is much close to the normally anatomic structure and the physical function.