改良联合术在原位肛门重建中的应用

Application of the Improvement Associated Procedure in Reconstructing Anus in Situ

为探讨低位直肠癌根治术后即时行改良联合术重建原位肛门的效果，对38例低位直肠癌患者行Miles术后即时行Ⅰ期改良联合术原位肛门整形重建。改良联合术：（1）肛门内括约肌为双层双环肌套Ⅰ（2）肛门外括约肌重建包括外括约肌的重建和外括约肌浅部与深部的重建；（3）直肠瓣为三个交叉的重建人工直肠瓣；（4）直肠后壁与肛尾韧带缝合固定形成的〈90°的角为重建的直肠角。结果显示，38例患者术后5～6d有便意感，2～3周有控便能力。术后随访总优良率达94．7％I5年生存率达76．3％。结果表明，低位直肠癌根治术后即时行改良联合术原位肛门整形重建效果显著，既能避免腹壁人工肛门的痛苦，又可提高患者的生活质量和远期生存率。

The 38 patients with low rectal cancer had been subiected to Miles operation and immediately received the improvement associated procedure for reconstructing anus in situ, so as to explore the efficacy of this associated procedure following radical operation. The associated procedure includes： 1）anal internal sphincters are double-layer and double-ring muscle suits; 2） on anal external sphincter,its reconstruction is external sphincter reconstruction and superficial-deep reconstruction of the sphincters3）rectal valves are 3 crossing artificial reconstruction; 4）on rectal angle, anal-tail ligament is sutured with rectal posterior wall to form the angle less than 90%. As results, all the patients had defecation awareness later 5-6 days after opera- tion,function controlling feces later 2-3 weeks; follow-ups indicated 94.7% of total excellent and better rate,and 76.3% of 5-year survival rate. Results show that after radical surgery for low rectal cancer imme- diately performing the associated procedure to reconstruct and plasty anus in situ can obtain significant efficacy, which not only can avoid pain from abdomen-wall artificial anus, but enhance the life quality of patient and long-term survival rate.