直肠拉出切除术治疗低位直肠癌的系列改进  

Serial modifications of bacon's pull through resection for low rectal cancer

作　　者：周锡庚[1] 冯国光[1] 郁宝铭[1] 沈耀祥[1] 

机构地区：[1]上海第二医科大学瑞金医院外科

出　　处：《中华外科杂志》1997年第12期716-718,共3页Chinese Journal of Surgery

摘　　要：为了提高Ｂａｃｏｎ式直肠拉出切除术后患者的排便控制能力，免去二期手术切除拉出结肠，作者对Ｂａｃｏｎ手术进行了４次改进。第一次保留了肛提肌，第二次保留了齿线和肛管移行区（肛管感觉），从而大大提高了排便控制能力；第三次改进简化了经肛门的切除操作。第四次改进将拟拉出的结肠端肠管环扎于螺纹内支撑管上，以替代结肠拉出，转流粪便。当环扎线远端肠管坏死脱落时，近侧肠管已与肛管内创面和盆壁靠拢愈合。这就免去二期手术切除肛门外结肠，从而缩短住院期，减轻了患者的痛苦和经济负担。本手术适应于在切除足够的癌远端肠管和周围组织后，肛提肌上剩余直肠不足１ｃｍ，很难经腹腔吻合的低位癌；从而扩大了保肛手术的适应范围。本手术是Ｐａｒｋｓ手术一种很好的替代。Four modifications of Bacon's pullthru resection were undertaken to improve postoperative defecatory control and to avoid the 2nd stage resection of the pullthru colon stump.54 cases of modified Bacon's rectal resection (964% of sphincter saving resections) were performed between 1954～1989.The 1st modification(1954)preserves the levator ani and the intact anorectal ring.The 2nd modification (1964) preserves the dentate margin and anal transitional zone (acute anal sensation),thus greatly improving defecatory control.The 3rd modification(1980) simplified intraanal resective procedure.The 4th modification(1991) was to encircle and ligate the distal end of colon over a sterilized corrugated intraluminal splinting tube (The other end of which is already connected to a long latex tube prior to operation).The latex tube was pulled out thru anus,until the colonic ligature reaches the Dentate margin,to substitute for colonic pullthru and to divert feces during & after operation,4～8 fine stitches approximate the colon wall 1 cm proximal to the ligature,to the cut edge of anal mucosa.The colon wall distal to the ligature sloughed in 7～10 days,the proximal colon has partially healed to the raw areas of anal canal without infection.The 2nd stage colon stump resection is thus obviated and hospitalization shortened.The postoperative anal function was good in 86.66%.Modified Bacon′s operation is indicated for very low rectal cancer when the rectal remnant above levator ani after adequate resection is less than 1cm which is difficult for intraabdominal anastomosis.It extends the scope of sphinctersaving operation.It is a good substitute for Park′s coloanal anastomosis.

关 键 词：直肠肿瘤 直肠结肠切除术 重建性 支架 

分 类 号：R735.370.5[医药卫生—肿瘤] R730.56[医药卫生—临床医学]