原位肛门整形重建3种改进术式效果比较

Comparative Study on the Results of 3 Kinds of Procedures for Anus Reconstruction in situ

为探讨直肠癌Miles术后同时一期原位肛门整形重建3种术式的临床效果，将90例低位直肠癌Miles根治术的病例分为3组。Ⅰ组20例，为单纯一期肛门外括约肌原位肛门重建（单纯组）。Ⅱ组32例，采用4项联合术重建肛门内括约肌、肛门外括约肌、直肠瓣、直肠角的原位肛门重建（联合术组）。Ⅲ组38例，为进一步改进的Ⅱ组术式行原位肛门重建（改进组）。结果显示，单纯组总优良率为70．0％，〉5年生存率50．0％；联合组总优良率90．6％，〉5年生存率为71．9％；改进组总优良率94．7％，〉5年生存率为76．3％。结果表明，原位肛门重建必须同时重建其肛门直肠的4大基本解剖结构，才能具有其基本控便功能，以达到接近正常人的生理功能及提高其远期生存率。

In order to compare the different results of 3 kinds of procedures, ninety cases with low rectal cancer were subjected 3 kinds of procedures of primary anus reconstruction in situ after Miles＇ operation,they were divided into 3 groups： 1st group（20 cases） ：simply primary anus reconstruction in situ with external anus sphinctor muscle, 2nd group（32 cases） ：primary anus reconstruction in situ with 4 reconstruction operatation,external anus sphinctor muscle, internal sphinctor muscle, rectal valves, and rectal angle reconstruction; 3rd group （38 cases） ： the improved operation of that like in 2nd group. Results showed in 1st group superior rate was 70. 0%,〉5yr survival rate 50.0% ;2nd group superior rate 90.6% ,〉5yr survival rate 71.9% ;3rd group superior rate 94.7% ,〉5yr survival rate 76. 3 %. Those show that the primary anus reconstruction would reconstruction the 4 basal anatomy structures of anus and rectum,so that the fundamental functions of defecation could be reconstruction.