改良Bacon术在低位直肠吻合口良性狭窄再次保肛手术中的应用  

Modified Bacon’s procedure as repeated sphincter-preserving operation for be⁃nign rectal anastomotic stenosis

作　　者：夏文豪 黄平 吴作友 张伟伟 翁和语 陈启 Xia Wenhao;Huang Ping;Wu Zuoyou;Zhang Weiwei;Weng Heyu;Chen Qi(Department of Colorectal and Anal Surgery,The Affiliated Sir Run Run Hospital of the Nanjing Medical University,Nanjing 211166,Jiangsu,China;Department of Colorectal and Anal Surgery,The First Affiliated Hospital of the Nanjing Medical University,Nanjing 221000,Ji-angsu,China)

机构地区：[1]南京医科大学附属逸夫医院结直肠肛门外科,江苏南京211166 [2]南京医科大学第一附属医院结直肠肛门外科,江苏南京221000

出　　处：《结直肠肛门外科》2022年第1期73-76,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的评价改良Bacon术在低位直肠吻合口良性狭窄再次保肛手术中的应用价值。方法回顾性分析南京医科大学附属逸夫医院采用改良Bacon术治疗的13例术后低位直肠吻合口良性狭窄再次保肛手术患者的临床资料,探讨改良Bacon术在低位直肠吻合口良性狭窄再次保肛手术中的应用价值。结果所有患者均顺利完成手术,手术时间300~535 min,中位手术时间384(330,458)min;术中出血量50~1150 mL,中位术中出血量375(75,450)mL。无术后出血、吻合口漏、肛门狭窄、骶前感染、肛门外置肠管坏死等并发症发生。1例患者于术后5个月发生直肠黏膜脱垂,予以切除脱垂黏膜,经术后提肛运动锻炼肛门括约肌后恢复良好。随访4个月至3年,术后半年时患者排粪功能恢复良好(Willianms评分:A级7例,B级4例,C级1例),排粪次数:1~2次/日者5例,3~4次/日者6例,>4次/日者1例。另1例随访时间为4个月的患者排粪功能为C级,排粪次数>4次/日。结论对于经多次机械扩张、内镜、介入治疗或其他非经腹手术治疗无效的低位直肠吻合口良性狭窄的患者,改良Bacon术可以作为保留肛门的一种理想术式。Objectives To evaluate the value of modified Bacon’s procedure as repeated sphincter-preserving operation for be⁃nign rectal anastomotic stenosis.Methods This was a retrospective analysis of 13 patients receiving modified Bacon’s procedure as repeated sphincter-preserving operation for benign rectal anastomotic stenosis at the Affiliated Sir Run Run Hospital of the Nanjing Medical University.We explored the value of this procedure as repeated sphincter-preserving operation for benign rectal anastomotic stenosis.Results All surgeries were uneventful.The duration of surgery ranged from 300 to 535 min with an medi⁃an duration of 384(330,458)min.The intraoperative blood loss ranged from 50 to 1150 mL with an median amount of 375(75,450)mL.There were no postoperative complications such as postoperative bleeding,anastomotic leakage,anal stenosis,presa⁃cral infection,and necrosis of the external bowel.One patient had rectal mucosal prolapse at five months after surgery,this pa⁃tient underwent resection of prolapsed mucosa and postoperative pelvic floor exercises for sphincter function and showed good re⁃covery.Patients were followed up for 4 months to 3 years.All patients showed good bowel function recovery at 6 months(Wil⁃lianms score:seven cases were grade A,four were grade B,and one was grade C).In terms of daily bowel movement,five pa⁃tients had 1~2 times,six patients had 3~4 times,and one patient had>4 times of bowel movement.The remaining one patient who was followed up for 4 months had grade C bowel function and>4 times of bowel movement per day.Conclusion For pa⁃tients with benign rectal anastomotic stenosis who failed multiple mechanical dilatation,endoscopy,interventional treatments,or oth⁃er non-abdominal surgeries,modified Bacon’s procedure could be considered sphincter-preserving treatment option.

关 键 词：直肠吻合口良性狭窄 改良BACON术 保肛手术 

分 类 号：R735.37[医药卫生—肿瘤]