原位肛门重建术中直肠角直肠瓣改进的应用效果观察

The Efficacies of Improved Rectal Angle and Rectal Valve in the Reconstruction of Anus in Situs

为观察改进的直肠角直肠瓣在原位肛门整形重建术中的临床应用效果，对38例低位直肠癌患者行Miles根治术后，行改进的直肠角直肠瓣原位肛门整形重建术。改进操作包括：（1）直肠角改为肛提肌缝合于括约肌外面与结肠前壁，后壁与肛尾韧带残端缝合固定成90°弯曲的新直肠角；（2）直肠瓣改为3个人工直肠瓣。结果显示，38例术后肛门功能测试的总优良率达94．7％，远期生存率76．3％。结果表明，改进的直肠角直肠瓣是原位肛门重建术的效果良好的保证，其术式的设计更符合正常解剖结构与生理功能。

The objective of this study was to observe clinical efficacies of improved rectal angle and rectal valve in the reconstruction of anus in situs. Following Mile＇s operation the 38 patients with lower rectal cancer immediately were subjected to above reconstruction. The improvements included.（1）on rectal angle, the anal levator was sutured to the outside of sphincter and to frontal layer of colon,what＇s back layer was sutured to the residual end of anococcygeal ligament and fixed to form 90° as novel rectal angle; （2）on rectal valve,it was constructed to three artificial rectal valves. The outcomes showed that the postoperative anal functions were excellent and good in 94. 7% of the 38 patients, and the long-term survival rate was 76.3%. These indicate that the improved rectal angle and valve are the guarantee to the good effects of reconstructing anus in situs, the design of this improved procedure much more accords with the normal ana- tomical structure and physical function.