直肠癌患者腹会阴切除和会阴结肠造瘘后进行的二次人造括约肌的植入  

Secondary implantation of an artificial sphincter after abdominoperineal resection and pseudocontinent perineal colostomy for rectal cancer

作　　者：Marchal F. Doucet C. Lechaux D. P.-A.Lehur 杨雪娟 

机构地区：[1]Clinique Chirurgicale II, Ple Digestif, Htel Dieu, Place Alexis Ricordeau, 44093 Nantes, France

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2005年第9期25-25,共1页Core Journals in Gastroenterology

摘　　要：Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. Patients-In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence,an Acticon Neosphincter(r) (AMS)was implanted consecutively at a mean 4.5 years after APR. Results-Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. Conclusion-In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case or previous radiotherapy. Midterm tolerance was satisfactory. Continence and quality of life significantly improved.Introduction-Fecal continence with a perineal colostomy performed after abdominoperineal resection (APR) is not always satisfactory despite retrograde colonic enemas. Functional improvement is currently examined using artificial sphincters. Preliminary results are disclosed. Patients-In 3 female patients, 45, 59 and 68 years old, curative APR and perineal colostomy were performed after radiotherapy in 2, for T1-2N0 cancer of the lower rectum. Due to occasional leaks, need for strict diet and fear of incontinence,an Acticon Neosphincter(r) (AMS)was implanted consecutively at a mean 4.5 years after APR. Results-Device implantation was feasible and uneventful. In one case, a superficial hematoma was drained and healed by second intention. Devices were activated 3 months after implantation. At a mean 2.5 years follow-up, the 3 patients had an activated and functional artificial sphincter. Leaks and fecal urgency significantly decreased but colonic enemas were maintained. Dietary restrictions were less and quality of life improved. All 3 considered the device as a useful adjunct. Conclusion-In this limited experience, implantation of artificial sphincter around a perineal colostomy following APR for rectal cancer appeared feasible and safe even in case or previous radiotherapy. Midterm tolerance was satisfactory. Continence and quality of life significantly improved.

关 键 词：腹会阴切除 肠癌患者 结肠造瘘 结肠造口 生活质量 大便失禁 放射治疗 活性功能 饮食限制 二次处理 

分 类 号：R735.37[医药卫生—肿瘤]