超低位直肠癌行臀大肌替代部分括约肌重建肛门

Using Gluteus Maximus Muscle to Reconstruct the Anal Sphincter for Very Low Rectal Cancer

目的:对超低位直肠癌采用臀大肌替代部分括约肌重建肛门,探讨其术后的局部复发及排便功能问题。方法:对16例超低位直肠癌患者采用臀大肌替代部分括约肌重建肛门,术后1个月进行生物反馈治疗,分别在治疗前、治疗后及术后1年进行直肠肛管向量测压,选择同期30例直肠癌低位前切除术及30例肛门功能正常的患者作为对照研究。结果:16例患者平均随访4.2年,无局部复发。臀大肌替代部分括约肌术的术后主观Vaizey评分和Wexner评分及客观直肠肛管向量测压结果均不如对照组(P<0.001),生物反馈治疗可以改善术后的肛门功能(P<0.001),1年后改善更加明显(P<0.001),但是无论与正常对照组还是低位前切除(LAR)对照组比较,仍然有显著性差异(P<0.001)。另外,直肠肛管反射的阳性率提高并不明显,术后1年阳性率达到31.3%。结论:超低位直肠癌患者采用臀大肌替代部分括约肌重建肛门由于手术适应证的选择,局部复发率低,排便功能短期内不甚理想,但是经过生物反馈治疗及长期的功能锻炼,达到比较满意程度,可以作为部分超低位直肠癌术式的选择。

Objective： To assess the use of gluteus maximus muscle to reconstruct the anal sphincter for very low rectal cancer. This study aimed to evaluate local recurrence and fimction of the new anal sphincter after surgery. Methods： Sixteen patients underwent the replacement procedure and then received biofeedback treatments 1 month after the operation. The therapeutic responses were eval- uated using the Vaizey and Wexner scoring systems and vectorial manometry. The 2 control groups were 30 cases who had undergone a low anterior resection for rectal cancer and 30 healthy people. Results： Median follow-up was 4.2 years. No local recurrence was observed. The Vaizey and Wexner scores and vectorial manometry results 1 month after surgery were significantly lower than those of the healthy and low anterior resection controls （P〈0.001）. After biofeedback treatments, the above indexes improved significantly （P〈0.001）, especially after 1 year （P〈0.001）, but still remained lower than the controls （P〈0.001）. The rectoanal reflex only increased to 31.3% 1 year after the surgery. Conclusion： Local recurrence was low after the replacement surgery. Defecation function was poor immediately following the surgery, but improved markedly after biofeedback treatments and long-term functional exercise. This therapy is one suitable choice for very low rectal cancer.