Kusunoki M, Shoji Y, Yanagi H, Fujita S, Hatada T, Sakanoue Y, Yamamura T, Utsunomiya J
Second Department of Surgery, Hyogo College of Medicine, Japan.
Surgery. 1992 Nov;112(5):876-83.
There has recently been increasing interest in coloanal reconstruction after proctectomy for low rectal carcinoma. We describe here our pilot experience with seven patients undergoing modified anoabdominal resection of the rectum and a colonic J-pouch anal anastomosis.
The procedure varied according to the extent of internal anal sphincter (IAS) resection (type a, partial resection of the upper IAS; type b, circumferential resection of the upper IAS; type c, partial preservation of the lower IAS; and type d, total resection of the IAS).
None of the patients had incontinence, but preservation of the lower half of the IAS (types a and b) showed functional superiority over more extensive IAS resection (types c and d). Only patients who underwent types c and d resection needed medications to reduce stool frequency.
Our results suggest that the lower half of the IAS has a more important role than the upper half in the control of defecation. Total resection of the IAS did not sacrifice continence, but preservation of at least the lower IAS resulted in a better quality of life. Careful patient selection is needed when considering the use of these procedures for tumors in the lowest part of the rectum.
近期，低位直肠癌直肠切除术后的结肠肛管重建越来越受到关注。在此，我们描述了7例接受改良直肠腹会阴切除术及结肠J袋肛管吻合术患者的初步经验。
手术方式根据肛门内括约肌（IAS）切除范围而异（a型，IAS上部部分切除；b型，IAS上部环形切除；c型，IAS下部部分保留；d型，IAS全部切除）。
所有患者均无大便失禁，但IAS下半部分保留（a型和b型）在功能上优于更广泛的IAS切除（c型和d型）。仅接受c型和d型切除的患者需要使用药物来减少排便次数。
我们的结果表明，在排便控制方面，IAS下半部分比上半部分发挥着更重要的作用。IAS全部切除并未牺牲控便能力，但至少保留IAS下半部分可带来更好的生活质量。在考虑将这些手术用于直肠最下部肿瘤时，需要仔细选择患者。
