原位肛门重建的实验研究及临床应用效果  

Experimental study of anal reconstruction in situ and evaluation of its clinical application

作　　者：曹秀峰[1] 肖建[1] 朱斌[1] 黄志华 王山 吴必超 黄水清[1] 王和明[1] 李义生[1] 

机构地区：[1]南京医科大学附属南京第一医院肿瘤中心,210006 [2]江苏省盐城市肿瘤医院外科

出　　处：《中华实验外科杂志》2007年第10期1209-1211,共3页Chinese Journal of Experimental Surgery

摘　　要：目的观察原位肛门重建术式的控便能力及其在低位直肠癌患者中的临床应用效果。方法对48只家猫采用4种不同的术式行原位肛门重建,即A,B、C三组切除肛门内外括约肌,其中A组游离股薄肌包裹;B组结肠套叠;C组结肠套叠加股薄肌包裹;D组结肠套叠保留肛门外括约肌。术前、术后1、3、6个月测量重建肛管及直肠内压。临床资料分为重建组和Miles组,每组60例,重建组的术式按动物实验C组方法原位肛门重建者48例,按D组手术方法原位肛门重建者12例。术后6个月以后评价控便效果,并分析重建组和Miles组的术后1、3、5年生存率。结果术后4组肛管内压及直肠内压均低于术前组(P<0.05);术后C、D组肛管内压及直肠内压高于术后A组(P<0.05);而A、B组之间以及C、D组之间差别无统计学意义(P>0.05)。应用C、D组术式治疗的60例直肠癌患者,术后控便功能优良者为78.33%(47/60);重建组术后1、3、5年生存率为:100.00%、68.33%、48.33%,Miles组术后1、3、5年生存率为98.33%、71.67%、45.00%。重建组和Miles组术后1、3、5年生存率差异无统计学意义(P>0.05)。结论原位肛门重建术既可根治肿瘤,同时能重建患者的排便功能。To study the self-control ability of defecation in anal reconstruction in situ and evaluate its clinical effect for the patients with low rectal carcinoma. Methods A research of anal reconstruction in situ for 48 cats was carried out with 4 different ways of operations, i e-A, B and C groups, the external and internal sphincters of anus were incised, and A： the gracilis muscle wrapped; B： the colic intussusception; C： the colic intussusception with gracilis muscle wrapped and D： the colic intussusception with the external sphincter retained. The anal and rectal pressures were measured and the evacuations of bowel were observed before and 1, 3, 6 months after operation. 120 patients were divided into reconstruction group arid Miles group （n = 60 each group）. In reconstruction group, 48 cases of artificial anus were reconstructed in situ with method C and 12 cases with method D. The defecation function was evaluated after 6 months and 1-, 3-, 5-year survival rate was analyzed. Results The anal and rectal pressure of the 4 animal groups was lower than that before operation （ P 〈 0.05）. In groups C and D, the pressure was higher than in groups A and B （ P 〈 0.05）. The difference between A and B or C and D had no statistical significance （ P 〉 0.05 ）. The operation method was performed on 60 clinical cases with a rate of satisfactory defecating function being 78.33% （47/60）. The postoperative 1-, 3- and 5-year survival rate was 100.00% , 68.33% and 48.33% in the reconstruction group and 98.33%, 71.67% and 45.00% in the Miles group, respectively. There was no significant difference （P 〉0.05）. Conclusion Anal reconstruction in situ could resect the tumor and rebuild the ability of defecation.

关 键 词：直肠肿瘤 肛门重建 生存率 

分 类 号：R735.37[医药卫生—肿瘤]