改进的原位肛门重建术的临床应用

Clinical Application of Improved in situ Anus Reconstruction

观察低位直肠痈根治术后即时行改进的原位肛¨重建术的效果，对38例低位直肠癌患者行Miles术后即时行改进的原位肛门重建术。原位肛门晕建术的改进：（1）肛门内括约肌重建为双层双环肌套；（2）肛门外括约肌的重建为肛门外括约肌浅部与深部的重建；（3）直肠瓣为三个重建人工直肠瓣；（4）直肠角与肛尾韧带缝合固定形成090。角，即重建的商肠角。结果表明，本组38例患者术后5～6d即有便意感，2～3周即仃控便能力，术后1个月即可排成形便，每口1～2次。肛门控液总优良率为94．7％（36／38）。术后5年生存牢为76．3％（29／38）。结果表明，低位直肠癌根治术后即时行改进的原位肛门重建术，既能避免腹壁人工肛门的痛苦，又口I提高患者的生活质量和远期生存率，效果显著。关键词低位直肠痛；根治术；改进的原化肛门重建术；效果摘要为观察低位直肠癌根治术后即时行改进的原位肛门重建术的效果，对38例低位直肠癌患者行Miles术后即时行改进的原位肛门重建术。原位肛门重建术的改进：（1）肛门内括约肌重建为双层双环肌套；（2）肛门外括约肌的重建为肛门外括约肌浅部与深部的重建；（3）直肠瓣为三个重建人工直肠瓣；（4）直肠角与肛尾韧带缝合固定形成〈90°角，即重建的直肠角。结果表明，本组38例患者术后5～6d即有便意感，2～3周即有控便能力，术后1个月即可排成形便，每日1～2次。肛门控液总优良率为94．7％（36／38）。术后5年生存率为76．3％（29／38）。结果表明，低位直肠癌根治术后即时行改进的原位肛门重建术，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，效果显著。

In order to investigate the efficacy of timely performing improved in situ anus reconstruction fol- lowing radical procedure for low rectal carcinoma, authors timely performed above anus reconstruction fol- lowing Miles procedure on 38 low rectal cancer patients. So called improvement included. I） reconstructed anus internal sphincter, as double-layer, double-ring muscle-cover ;2） for anus external sphincter, superficial site and deep site reconstruction; 3）for rectal valve, three artificial reconstruction valves; 4）reconstructed rectal angle,i, e suturing original rectal angle and anococcygeal ligament to form the angle 〈90°. As results ,all of the 38 patients had just defecation awareness later 5-6 days after operation,just control-feces a- bility later 2-3 weeks,just formed feces later one month,and 1-2 times/day,in control-liquid total excellent and good rate was 94. 7% （36/38）, 5-year postoperative survival rate was 76.3o//oo （29/38）. Results show that timely performing improved in situ anus reconstruction following radical procedure for low rectal cancer not only can avoid patient＇s pain from abdomen-wall artificial anus, but can enhance the quality of patient ＇s life and long-term survival rate, and its efficacy is significant.