带血管蒂肠肌移植节制性结肠造口初步探讨

Continent colostomy by transplanting the smooth muscle with blood vessel

目的 :探讨带血管蒂肠肌自体移植节制性结肠造口的功能。方法 :对 11例直肠癌行Mile’s术式患者取带有结肠系膜及血供的一段结肠长约 10cm ,去除黏膜 ,包绕移植于造口段结肠浆肌层外 ,形成 5cm宽的带血管蒂肠肌的人工内括约肌环 ,观察造口节制功能。结果 :术后平均观察 32个月 ,造口结肠血循环良好 ,未见移植物感染和坏死。全组节制功能良好 ,每天造口灌洗后平均 2 4h不需使用造口用具。 8例行测压检查 ,造口处静息压平均为 (39.0± 8.3)mmHg。结论 :带血管蒂节制性结肠造口移植物感染、坏死率低 。

Objective:To probe into the function of continent colostomy by transplanting the smooth muscle with blood vessel.Methods:A colon with a length of 10cm with mesocolon and blood supply was taken from 11 patients with rectal cancer who underwent Miles operation and wapped on seromuscular layer after wiping out the mucous.The grafts formed a smooth muscle loop with a length of 5cm.The continent function was observed.Results:All the patients were followed up for an average of 32 months.Blood supply of the colostomy was good.No infection or necrosis developed in all grafts.The continent function of all patients was good and did not need colostomy appliance 24h after enema.Eight cases underwent manometric examination and the average rest pressure was(39.0±8.3)mmHg in colostomy.Conclusions:The continent colostomy by transplating the smooth muscle with blood vessel has a better continent function and the grafts have a lower rate of infection or necrosis.